MEDICARE: DR. CHANTAY P WHITE-ELEY LCSW

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	1041C0700X	Clinical Social Worker	Q10000842	DE

General Provider Information

NPI Number	:	1184761256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANTAY P WHITE-ELEY LCSW

Provider Business Mailing Address
First Line	:	316 LISMORE DR
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-6512
Country	:	US
Telephone Number	:	253-576-8514
Fax Number	:	240-846-5999

Provider Business Practice Location Address
First Line	:	2121 EISENHOWER AVE STE 301
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4688
Country	:	US
Telephone Number	:	253-576-8514
Fax Number	:	240-846-5999

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	01/29/2024

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