Provider Demographics
NPI:1912313735
Name:WHITE, GEORGE DAVID (LGPC, NCC, MS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:DAVID
Last Name:WHITE
Suffix:
Gender:M
Credentials:LGPC, NCC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 BANNEKER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3156
Mailing Address - Country:US
Mailing Address - Phone:410-457-3196
Mailing Address - Fax:
Practice Address - Street 1:5401 TWIN KNOLLS RD STE 9
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3257
Practice Address - Country:US
Practice Address - Phone:443-803-0877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MDLGP4220101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional