Provider Information for 1649796004
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JOANNA WHITE lsw
Sex: Female
NPI: 1649796004
Last Updated: 2022-07-21
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1649796004 | ||||||||
| Enumeration Date | 2017-08-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2211 ARBOR BLVD MORAINE, OH 45439-1521 United States Phone: 937-222-9481 | Fax: | ||||||||
| Primary Practice Address | 2211 ARBOR BLVD MORAINE, OH 45439-1521 United States Phone: 937-222-9481 | Fax: | ||||||||
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