Healthcare Provider Details

I. General information

NPI: 1144934852
Provider Name (Legal Business Name): XAVIER DIRELL WILLIS M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2867 MAYFIELD RD APT 1
CLEVELAND HEIGHTS OH
44118-1633
US

IV. Provider business mailing address

2867 MAYFIELD RD APT 1
CLEVELAND HEIGHTS OH
44118-1633
US

V. Phone/Fax

Practice location:
  • Phone: 216-645-8677
  • Fax:
Mailing address:
  • Phone: 216-645-8677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: