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General NPI Number Information
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NPI Number | 1386622934
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Entity Type | Individual
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Provider Name | KEVIN JAMES WILLIAMSON PCC-S
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Gender | Male
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 3500 CARNEGIE AVE
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City | CLEVELAND
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State | OH
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Zip | 44115-2641
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Country | US
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Telephone | 440-260-8436
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Fax | 440-260-8576
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Provider Business Mailing Address
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Address Line | 3500 CARNEGIE AVE
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City | CLEVELAND
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State | OH
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Zip | 44115-2641
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Country | US
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Telephone | 440-260-8436
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Fax | 440-260-8576
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701002759
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E.0008231-SUPV
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License Number State | OH
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