Healthcare Provider Details

I. General information

NPI: 1861805434
Provider Name (Legal Business Name): GENICE MARIE WILLIAMS-RIVERS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/09/2024
Certification Date: 06/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12677 TALL TIMBER CIR
NORTH ROYALTON OH
44133-3711
US

IV. Provider business mailing address

12677 TALL TIMBER CIR
NORTH ROYALTON OH
44133-3711
US

V. Phone/Fax

Practice location:
  • Phone: 216-562-7214
  • Fax: 440-457-7088
Mailing address:
  • Phone: 216-562-7214
  • Fax: 440-457-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1800944
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: