Active NPI
Angela Ann White, M.A., M.ED, RMHCI
- Behavior Technician
- Jacksonville, FL
National Provider Identifier
1376077305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- BACB384055
- Practice address
- 3670 Kirkpatrick Cir Unit 5
Jacksonville, FL 32210-0208 - Phone
- (412) 999-2884
- NPI assigned
- Apr 17, 2017
- Last updated
- Sep 6, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Behavior Technician | 106S00000X | BACB384055 | FL | Primary |
Addresses
Primary practice location
3670 Kirkpatrick Cir Unit 5
Jacksonville, FL 32210-0208
Mailing address
3670 Kirkpatrick Cir Unit 5
Jacksonville, FL 32210-0208
Phone (412) 999-2884
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020993800 | Medicaid | FL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Sharepoint | Health Information Exchange (HIE) | Positive Behavior Supports Corporation |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education, Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BACB384055 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662422400000",
"number": "1376077305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3670 KIRKPATRICK CIR UNIT 5",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322100208",
"telephone_number": "412-999-2884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3670 KIRKPATRICK CIR UNIT 5",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322100208",
"telephone_number": "412-999-2884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "ANGELA",
"middle_name": "ANN",
"credential": "M.A., M.ED, RMHCI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-17",
"last_updated": "2022-09-06",
"certification_date": "2022-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "BACB384055",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "020993800",
"state": "FL"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Sharepoint",
"affiliation": "Y",
"endpointDescription": "Sharepoint",
"affiliationName": "Positive Behavior Supports Corporation",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "3670 Kirkpatrick Cir Unit 5",
"city": "Jacksonville",
"state": "FL",
"country_code": "US",
"postal_code": "322100208",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.