Healthcare Provider Details

I. General information

NPI: 1922640671
Provider Name (Legal Business Name): WILL DEWAYNE RAINGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 EUCLID AVE
CLEVELAND OH
44103-3703
US

IV. Provider business mailing address

3942 LEE HEIGHTS BLVD
CLEVELAND OH
44128-1735
US

V. Phone/Fax

Practice location:
  • Phone: 216-881-0765
  • Fax: 216-431-2190
Mailing address:
  • Phone: 216-854-2965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number192827
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: