Healthcare Provider Details

I. General information

NPI: 1225535610
Provider Name (Legal Business Name): LYNDA MARIE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E 55TH ST
CLEVELAND OH
44103-1304
US

IV. Provider business mailing address

2472 WARREN PKWY APT 17
TWINSBURG OH
44087-1363
US

V. Phone/Fax

Practice location:
  • Phone: 216-391-6672
  • Fax:
Mailing address:
  • Phone: 330-405-4871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number150448
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.000933
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: