Provider Demographics
NPI:1215216668
Name:WHITE, TERRY (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:
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 1:801 KEY HIGHWAY
Mailing Address - Street 2:SUITE 442
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-3504
Mailing Address - Country:US
Mailing Address - Phone:301-758-3682
Mailing Address - Fax:
Practice Address - Street 1:400 E. PRATT ST.
Practice Address - Street 2:SUITE 800
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3504
Practice Address - Country:US
Practice Address - Phone:443-759-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17157104100000X, 251S00000X
MD17157/0896253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD091029500Medicaid