Healthcare Provider Details

I. General information

NPI: 1396767638
Provider Name (Legal Business Name): SHARON WILLIAMSON BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 FULTON AVE
CINCINNATI OH
45206
US

IV. Provider business mailing address

91 N MAIN ST
WALTON KY
41094-1130
US

V. Phone/Fax

Practice location:
  • Phone: 513-961-4663
  • Fax:
Mailing address:
  • Phone: 407-489-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1451199
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.131191
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: