Healthcare Provider Details

I. General information

NPI: 1053758797
Provider Name (Legal Business Name): CORRINE L WHITE MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2057 S LIMESTONE ST
SPRINGFIELD OH
45505-4727
US

IV. Provider business mailing address

24 N HEDGES ST
DAYTON OH
45403-1321
US

V. Phone/Fax

Practice location:
  • Phone: 513-275-6447
  • Fax:
Mailing address:
  • Phone: 937-545-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: