Healthcare Provider Details

I. General information

NPI: 1346998226
Provider Name (Legal Business Name): LAURYN WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LIBERTY LN
WEST CARROLLTON OH
45449-2135
US

IV. Provider business mailing address

103 W MAIN ST
WEST CARROLLTON OH
45449-1421
US

V. Phone/Fax

Practice location:
  • Phone: 937-247-2400
  • Fax:
Mailing address:
  • Phone: 174-034-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: