MEDICARE: CHARLES B WILLIAMS CDCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	150490	OH

General Provider Information

NPI Number	:	1225502214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES B WILLIAMS CDCA

Provider Business Mailing Address
First Line	:	173 NOTRE DAME AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45404-1925
Country	:	US
Telephone Number	:	937-750-6926
Fax Number	:

Provider Business Practice Location Address
First Line	:	173 NOTRE DAME AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45404-1925
Country	:	US
Telephone Number	:	937-750-6926
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	01/14/2019

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Directions to “ CHARLES B WILLIAMS CDCA” Practice Location

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