Provider Demographics
NPI:1083311898
Name:WHITE, ZENA ASHLEY (LGPC)
Entity Type:Individual
Prefix:
First Name:ZENA
Middle Name:ASHLEY
Last Name:WHITE
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 B ST APT 400
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-7111
Mailing Address - Country:US
Mailing Address - Phone:516-661-5551
Mailing Address - Fax:
Practice Address - Street 1:23 B ST APT 400
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-7111
Practice Address - Country:US
Practice Address - Phone:516-661-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty