Healthcare Provider Details

I. General information

NPI: 1306485214
Provider Name (Legal Business Name): TONYA WILLIAMS BASW,CDCA,CPRS, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 E 22ND ST FL 4
CLEVELAND OH
44115-3209
US

IV. Provider business mailing address

PO BOX 932004
CLEVELAND OH
44193-0007
US

V. Phone/Fax

Practice location:
  • Phone: 216-363-2570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.162423
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2005708
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberLCDCIII.162423
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberLCDCIII.162423
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: