Provider Demographics
NPI:1023201233
Name:WHITE, CYNTHIA VELERIANEE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:VELERIANEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:VELERIANEE
Other - Last Name:JEFFERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2240 BRIDLE PATH DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2944
Mailing Address - Country:US
Mailing Address - Phone:301-638-0140
Mailing Address - Fax:
Practice Address - Street 1:2240 BRIDLE PATH DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2944
Practice Address - Country:US
Practice Address - Phone:301-638-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD58956180Medicaid
MD58956180Medicaid