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General NPI Number Information
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NPI Number | 1801367594
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Entity Type | Individual
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Provider Name | TANGIE LAVERN WHITE LGPC
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Gender | Female
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 401 CARROLL ST STE 106
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City | LA PLATA
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State | MD
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Zip | 20646-5987
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Country | US
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Telephone | 240-441-0894
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Fax | 240-776-4047
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Provider Business Mailing Address
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Address Line | 8410 SWEENEY DR
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City | CLINTON
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State | MD
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Zip | 20735-1979
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Country | US
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Telephone | 240-441-0894
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LGP9101
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License Number State | MD
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