Provider Demographics
NPI:1083496673
Name:WHITE, JASMINE ISABELLA (LGPC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ISABELLA
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 1:110 THOMAS JOHNSON DR STE 155
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4448
Mailing Address - Country:US
Mailing Address - Phone:240-317-4532
Mailing Address - Fax:301-228-9944
Practice Address - Street 1:110 THOMAS JOHNSON DR STE 155
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4448
Practice Address - Country:US
Practice Address - Phone:240-317-4532
Practice Address - Fax:301-228-9944
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14365101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional