Healthcare Provider Details

I. General information

NPI: 1659121283
Provider Name (Legal Business Name): LISA WHITE PHD, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CROSS POINTE RD STE 800D
GAHANNA OH
43230-6687
US

IV. Provider business mailing address

800 CROSS POINTE RD STE 800D
GAHANNA OH
43230-6687
US

V. Phone/Fax

Practice location:
  • Phone: 614-835-6068
  • Fax: 614-524-0428
Mailing address:
  • Phone: 614-835-6068
  • Fax: 614-524-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: