Healthcare Provider Details

I. General information

NPI: 1750880316
Provider Name (Legal Business Name): DATAIRA I WILLIAMS BSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11590 CENTURY BOULEVARD SUITE 116
CINCINNATI OH
45264-3217
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9056
US

V. Phone/Fax

Practice location:
  • Phone: 513-771-7239
  • Fax:
Mailing address:
  • Phone: 419-695-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2005438
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: