Provider Demographics
NPI:1841727625
Name:WHITE, DANITA MARIE (LISW)
Entity type:Individual
Prefix:
First Name:DANITA
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:DANITA
Other - Middle Name:MARIE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:6338 SNIDER RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9998
Mailing Address - Country:US
Mailing Address - Phone:513-879-3677
Mailing Address - Fax:
Practice Address - Street 1:6338 SNIDER RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9998
Practice Address - Country:US
Practice Address - Phone:513-879-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.141215101YA0400X
OHL.24050951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)