Provider Demographics
NPI:1457814212
Name:WHITE, COLLEEN (LMSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMSW
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 489
Mailing Address - Street 2:
Mailing Address - City:SECRETARY
Mailing Address - State:MD
Mailing Address - Zip Code:21664-0489
Mailing Address - Country:US
Mailing Address - Phone:410-943-8108
Mailing Address - Fax:410-943-3976
Practice Address - Street 1:3680 WARWICK RD
Practice Address - Street 2:
Practice Address - City:EAST NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21631-1420
Practice Address - Country:US
Practice Address - Phone:410-943-8108
Practice Address - Fax:410-943-3976
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker