Individual
TRAVAUGHN DOMINIC WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3500 CARNEGIE AVE, CLEVELAND, OH 44115-2641
(216) 372-3523
Mailing address
434 EASTLAND RD, BEREA, OH 44017-1217
(216) 372-3523
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
OH
251S00000X
Community/Behavioral Health Agency
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
VB326494
—
OH
Enumeration date
12/10/2019
Last updated
12/27/2019
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