Provider Demographics
NPI:1740625748
Name:WHITE, KATIE REBECCA (LCSW-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:REBECCA
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3559 MCSHANE WAY
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-5958
Mailing Address - Country:US
Mailing Address - Phone:410-459-0856
Mailing Address - Fax:
Practice Address - Street 1:3559 MCSHANE WAY
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-5958
Practice Address - Country:US
Practice Address - Phone:410-459-0856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD144531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical