Provider Demographics
NPI:1629664800
Name:WHITE, WILLIAM HOWARD
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HOWARD
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12118 STATE ROUTE 29
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43044-9542
Mailing Address - Country:US
Mailing Address - Phone:937-631-1819
Mailing Address - Fax:
Practice Address - Street 1:600 DOROTHY MOORE AVE UNIT 13
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-7407
Practice Address - Country:US
Practice Address - Phone:937-652-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker