Healthcare Provider Details

I. General information

NPI: 1437647286
Provider Name (Legal Business Name): MS. DEBORAH ANN WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 E MARKET ST
LIMA OH
45801-4535
US

IV. Provider business mailing address

311 E MARKET ST
LIMA OH
45801-4535
US

V. Phone/Fax

Practice location:
  • Phone: 419-335-3355
  • Fax: 419-222-4007
Mailing address:
  • Phone: 419-335-3355
  • Fax: 419-222-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number165328
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: