Healthcare Provider Details

I. General information

NPI: 1871155176
Provider Name (Legal Business Name): WASHINGTON WELLNESS INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 E 185TH ST
CLEVELAND OH
44119-2174
US

IV. Provider business mailing address

780 E 185TH ST
CLEVELAND OH
44119-2174
US

V. Phone/Fax

Practice location:
  • Phone: 216-681-9264
  • Fax: 216-282-8596
Mailing address:
  • Phone: 216-681-9264
  • Fax: 216-282-8596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM WASHINGTON
Title or Position: OWNER
Credential: LPCC
Phone: 216-302-8620