Healthcare Provider Details

I. General information

NPI: 1184089757
Provider Name (Legal Business Name): PEOPLE WITH VISIONS GOING PLACES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 CRAWFORD RD
CLEVELAND OH
44106-1511
US

IV. Provider business mailing address

1607 CRAWFORD RD
CLEVELAND OH
44106-1511
US

V. Phone/Fax

Practice location:
  • Phone: 614-843-5015
  • Fax: 216-860-4502
Mailing address:
  • Phone: 614-843-5015
  • Fax: 216-860-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number050155
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number050155
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number050155
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number050155
License Number StateOH

VIII. Authorized Official

Name: MS. ALECEANDRIA DENISE WILLIAMSON
Title or Position: CEO
Credential: CDCA, BA,MA,QMHS,
Phone: 614-843-5015