Provider Demographics
NPI:1467733956
Name:WHITE, ERIN ELISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:ELISE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:E. E.
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:320 COVENTRY CT APT 654
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1269
Mailing Address - Country:US
Mailing Address - Phone:269-317-5402
Mailing Address - Fax:
Practice Address - Street 1:3081 SULLIVANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-1831
Practice Address - Country:US
Practice Address - Phone:614-278-0200
Practice Address - Fax:614-274-0937
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021638103TF0200X
390200000X
OHP.07934103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program