Provider Demographics
NPI:1881822633
Name:WHITE, AMY MARIE (PHD, LPC, MAC, CCTP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD, LPC, MAC, CCTP
Other - Prefix:
Other - First Name:GREG
Other - Middle Name:ALLEN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3345 SHERRIE ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4061
Mailing Address - Country:US
Mailing Address - Phone:907-720-1130
Mailing Address - Fax:907-771-0588
Practice Address - Street 1:3345 SHERRIE ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4061
Practice Address - Country:US
Practice Address - Phone:907-727-4455
Practice Address - Fax:907-771-0588
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101YA0400X, 101YM0800X
AKPCOP639101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00430OtherBLUE CROSS BLUE SHIELD FEDERAL EMPLOYEE PROGRAM
AK00430OtherBLUE CROSS BLUE SHIELD
MN41124OtherMERITAIN HEALTH
TX84980OtherBLUE CROSS BLUE SHIELD TEXAS
KY60054OtherAETNA LIFE INSURANCE COMPANY