Individual
MARY T. WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., L.P.C.
Contact information
Practice address
198 MAIN STREET, SUITE 1, ELLSWORTH, ME 04605-1941
(207) 667-1153
(207) 667-1153
Mailing address
198 MAIN STREET, SUITE 1, ELLSWORTH, ME 04605-1941
(207) 667-1153
(207) 667-1153
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PC1124
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SSN - SOLE PROPRIETORSHIP
ME
01
—
348180
TRICARE PIN NUMBER
ME
01
—
7944152
AETNA PIN NUMBER
ME
Enumeration date
09/28/2006
Last updated
05/21/2020
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