Individual
MUNDRAE DALLAS WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCADC
Contact information
Practice address
3218 MAYFAIR RD, BALTIMORE, MD 21207-4561
(410) 725-8611
Mailing address
3218 MAYFAIR RD, BALTIMORE, MD 21207-4561
(410) 725-8611
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCA2225
MD
Other
Enumeration date
02/29/2016
Last updated
02/29/2016
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