Healthcare Provider Details

I. General information

NPI: 1184230245
Provider Name (Legal Business Name): VICTORIA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E CHESTNUT ST
MOUNT VERNON OH
43050-3404
US

IV. Provider business mailing address

13001 OLD MANSFIELD RD
MOUNT VERNON OH
43050-9704
US

V. Phone/Fax

Practice location:
  • Phone: 740-326-9255
  • Fax:
Mailing address:
  • Phone: 740-390-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.175658
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: