Healthcare Provider Details

I. General information

NPI: 1891328134
Provider Name (Legal Business Name): CONNOR WHITE CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N YELLOW SPRINGS ST
SPRINGFIELD OH
45504-2650
US

IV. Provider business mailing address

446 MORGAN ST
CINCINNATI OH
45206-2348
US

V. Phone/Fax

Practice location:
  • Phone: 513-834-7063
  • Fax: 513-873-1567
Mailing address:
  • Phone: 513-834-7063
  • Fax: 513-873-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.172503
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: