Healthcare Provider Details

I. General information

NPI: 1558296814
Provider Name (Legal Business Name): DARA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 E INNIS AVE
COLUMBUS OH
43207-2132
US

IV. Provider business mailing address

1308 E INNIS AVE
COLUMBUS OH
43207-2132
US

V. Phone/Fax

Practice location:
  • Phone: 614-432-6108
  • Fax:
Mailing address:
  • Phone: 614-432-6108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: