Provider Demographics
NPI:1043850464
Name:WHITE, AMY (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PLC
Mailing Address - Street 1:2 CARDINAL PARK DR SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4437
Mailing Address - Country:US
Mailing Address - Phone:571-473-5609
Mailing Address - Fax:
Practice Address - Street 1:2 CARDINAL PARK DR SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4437
Practice Address - Country:US
Practice Address - Phone:540-486-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.0135883TELE1041C0700X
DEQ5-00000491041C0700X
MA1255501041C0700X
VA09040138411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical