Provider Demographics
NPI:1568932622
Name:WHITE, JASMINE GENETTA
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:GENETTA
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7157 MAHOGANY DR
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5818
Mailing Address - Country:US
Mailing Address - Phone:301-456-0528
Mailing Address - Fax:
Practice Address - Street 1:7157 MAHOGANY DR
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-5818
Practice Address - Country:US
Practice Address - Phone:301-456-0528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7845101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional