Provider Demographics
NPI:1942904727
Name:WHITE, DAVID LEE
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
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 1:13040 CLEVELAND RD SW
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-9345
Mailing Address - Country:US
Mailing Address - Phone:614-736-9574
Mailing Address - Fax:
Practice Address - Street 1:40 S JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1696
Practice Address - Country:US
Practice Address - Phone:614-534-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)