Healthcare Provider Details

I. General information

NPI: 1457818874
Provider Name (Legal Business Name): MELISSA WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 W 117TH ST
CLEVELAND OH
44111-1642
US

IV. Provider business mailing address

11408 LINNET AVE
CLEVELAND OH
44111-4748
US

V. Phone/Fax

Practice location:
  • Phone: 216-417-4831
  • Fax:
Mailing address:
  • Phone: 216-972-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.168233
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number0001790
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: