Provider Demographics
NPI:1861756793
Name:WHITE, ZACHARY KARL
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:KARL
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6917 DONACHIE RD APT C
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-1111
Mailing Address - Country:US
Mailing Address - Phone:785-766-3618
Mailing Address - Fax:
Practice Address - Street 1:6917 DONACHIE RD APT C
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-1111
Practice Address - Country:US
Practice Address - Phone:785-766-3618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health