MEDICARE: ALAYSIA NICOLE WHITE

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1740898733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAYSIA NICOLE WHITE

Provider Business Mailing Address
First Line	:	3502 CAPTAIN WENDELL PRUITT WAY
Second Line	:
City	:	FT WASHINGTON
State	:	MD
Zip	:	20744-1543
Country	:	US
Telephone Number	:	202-904-7751
Fax Number	:

Provider Business Practice Location Address
First Line	:	3502 CAPTAIN WENDELL PRUITT WAY
Second Line	:
City	:	FT WASHINGTON
State	:	MD
Zip	:	20744-1543
Country	:	US
Telephone Number	:	202-904-7751
Fax Number	:

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

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	07/16/2020

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Directions to “ ALAYSIA NICOLE WHITE ” Practice Location

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