Healthcare Provider Details

I. General information

NPI: 1437610250
Provider Name (Legal Business Name): LONNIE WILLIAMS CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WASHINGTON AVE
CLEVELAND OH
44113-2333
US

IV. Provider business mailing address

1320 WASHINGTON AVE
CLEVELAND OH
44113-2333
US

V. Phone/Fax

Practice location:
  • Phone: 216-781-0550
  • Fax:
Mailing address:
  • Phone: 216-781-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number169202
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: