MEDICARE: MS. AMY JO WHITE L.C.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LC2138	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063587897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY JO WHITE L.C.P.C.

Provider Business Mailing Address
First Line	:	18209 LEMAN LAKE DR
Second Line	:	508B
City	:	OLNEY
State	:	MD
Zip	:	20832-3000
Country	:	US
Telephone Number	:	301-775-9661
Fax Number	:	301-830-6862

Provider Business Practice Location Address
First Line	:	2931 OLNEY SANDY SPRING RD
Second Line	:	F
City	:	OLNEY
State	:	MD
Zip	:	20832-1527
Country	:	US
Telephone Number	:	301-775-9661
Fax Number	:	301-830-6862

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	01/07/2016

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