Provider Demographics
NPI:1063843639
Name:WHITE, JUSTIN LANKFORD (CSC-AD PROVISIONAL)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:LANKFORD
Last Name:WHITE
Suffix:
Gender:M
Credentials:CSC-AD PROVISIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-0229
Mailing Address - Country:US
Mailing Address - Phone:410-778-7055
Mailing Address - Fax:410-778-7052
Practice Address - Street 1:300 SCHEELER RD
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1014
Practice Address - Country:US
Practice Address - Phone:410-778-7055
Practice Address - Fax:410-778-7052
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor