Healthcare Provider Details

I. General information

NPI: 1891397105
Provider Name (Legal Business Name): MRS. MICHELLE LANAE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S GREEN RD STE 307
SOUTH EUCLID OH
44121-3976
US

IV. Provider business mailing address

1414 S GREEN RD STE 203
CLEVELAND OH
44121-3937
US

V. Phone/Fax

Practice location:
  • Phone: 216-340-7484
  • Fax:
Mailing address:
  • Phone: 216-456-2090
  • Fax: 216-777-2063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number260420981009
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: