Healthcare Provider Details

I. General information

NPI: 1982240156
Provider Name (Legal Business Name): CLORISSA D. WILLIAMS LPC, LICDC, LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CLORISSA OGLE

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4653 E MAIN ST
WHITEHALL OH
43213-3298
US

IV. Provider business mailing address

4653 E MAIN ST
WHITEHALL OH
43213-3298
US

V. Phone/Fax

Practice location:
  • Phone: 614-384-7798
  • Fax: 614-384-7703
Mailing address:
  • Phone: 614-384-7798
  • Fax: 614-384-7703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number88001804A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2405880
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number162551
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: