Provider Demographics
NPI:1962918763
Name:WHITE, MELODY L (LSW)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-0022
Mailing Address - Country:US
Mailing Address - Phone:614-226-4646
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 22
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-0022
Practice Address - Country:US
Practice Address - Phone:614-226-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-17
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1430056104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker