Provider Demographics
NPI:1124276134
Name:WHITE, MICHELE MARIE MATTSON (LCPC, LCADC)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:MARIE MATTSON
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 CATHEDRAL ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5442
Mailing Address - Country:US
Mailing Address - Phone:410-496-6441
Mailing Address - Fax:
Practice Address - Street 1:1001 CATHEDRAL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5442
Practice Address - Country:US
Practice Address - Phone:410-496-6441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2979101YP2500X
MDLGA1533101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)