Provider Demographics
NPI:1063587897
Name:WHITE, AMY JO (LCPC)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:JO
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCPC
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Mailing Address - Street 1:18209 LEMAN LAKE DR
Mailing Address - Street 2:508B
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-3000
Mailing Address - Country:US
Mailing Address - Phone:301-775-9661
Mailing Address - Fax:301-830-6862
Practice Address - Street 1:2931 OLNEY SANDY SPRING RD
Practice Address - Street 2:F
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1527
Practice Address - Country:US
Practice Address - Phone:301-775-9661
Practice Address - Fax:301-830-6862
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDLC2138101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD265674Medicaid