Healthcare Provider Details

I. General information

NPI: 1770700775
Provider Name (Legal Business Name): WILLIAM DEFELICE LPCC AND LICDC-CS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 LEE RD
SHAKER HEIGHTS OH
44120-3649
US

IV. Provider business mailing address

3435 LEE RD
SHAKER HEIGHTS OH
44120-3649
US

V. Phone/Fax

Practice location:
  • Phone: 216-752-9090
  • Fax: 216-752-9080
Mailing address:
  • Phone: 216-752-9090
  • Fax: 216-752-9080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0002866
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number975961
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: