Provider Demographics
NPI:1801367594
Name:WHITE, TANGIE LAVERN (LGPC)
Entity Type:Individual
Prefix:MRS
First Name:TANGIE
Middle Name:LAVERN
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 1:8410 SWEENEY DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1979
Mailing Address - Country:US
Mailing Address - Phone:240-441-0894
Mailing Address - Fax:
Practice Address - Street 1:401 CARROLL ST STE 106
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5987
Practice Address - Country:US
Practice Address - Phone:240-441-0894
Practice Address - Fax:240-776-4047
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9101101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional