Healthcare Provider Details

I. General information

NPI: 1770091399
Provider Name (Legal Business Name): WILLIAMS FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14972 CAROL DR
MAPLE HEIGHTS OH
44137-4457
US

IV. Provider business mailing address

14972 CAROL DR
MAPLE HEIGHTS OH
44137-4457
US

V. Phone/Fax

Practice location:
  • Phone: 216-990-9785
  • Fax:
Mailing address:
  • Phone: 216-990-9785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1500999-SUPV
License Number StateOH

VIII. Authorized Official

Name: MARTIN L WILLIAMS
Title or Position: OWNER/THERAPIST
Credential: MSSA, LISW-S
Phone: 216-990-9785