Provider Demographics
NPI:1639788904
Name:WHITE, JAMIKA
Entity Type:Individual
Prefix:
First Name:JAMIKA
Middle Name:
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 1:1478 BRADEN LOOP
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5017
Mailing Address - Country:US
Mailing Address - Phone:443-569-9093
Mailing Address - Fax:
Practice Address - Street 1:1478 BRADEN LOOP
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5017
Practice Address - Country:US
Practice Address - Phone:443-569-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker