Healthcare Provider Details

I. General information

NPI: 1245717289
Provider Name (Legal Business Name): ANASTASIA LACURE WILLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 22ND ST
TOLEDO OH
43604-2706
US

IV. Provider business mailing address

27072 CARRONADE DR STE A103
PERRYSBURG OH
43551-5300
US

V. Phone/Fax

Practice location:
  • Phone: 419-475-4449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2304358-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: