Provider Demographics
NPI:1174656714
Name:WHITE, WILLIAM JOHN (LPCC,LICDC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOHN
Last Name:WHITE
Suffix:
Gender:M
Credentials:LPCC,LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1620
Mailing Address - Country:US
Mailing Address - Phone:440-354-5411
Mailing Address - Fax:
Practice Address - Street 1:8445 MUNSON RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-2410
Practice Address - Country:US
Practice Address - Phone:440-255-1700
Practice Address - Fax:440-205-2417
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH82822101YA0400X
OHE1396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health