Provider Demographics
NPI:1457363764
Name:WHITE, JAMELL DELAINE (LCSW-C)
Entity type:Individual
Prefix:
First Name:JAMELL
Middle Name:DELAINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WOOD HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8724
Mailing Address - Country:US
Mailing Address - Phone:301-838-4200
Mailing Address - Fax:301-309-2596
Practice Address - Street 1:200 WOOD HILL RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8724
Practice Address - Country:US
Practice Address - Phone:301-838-4200
Practice Address - Fax:301-309-2596
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10883104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD235571OtherKAISER
MD292407000OtherMAGELLAN
MD530196598OtherTRICARE
MD901100500Medicaid
DCA2840097OtherBCBS
MD7203306OtherAETNA
MD292407000OtherMAGELLAN