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General NPI Number Information
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NPI Number | 1629102116
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Entity Type | Organization
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Legal Business Name | WILLIE. S. WILLIAMS, PH.D., LLC
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 09/08/2015
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Provider Practice Location Address
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Address Line | 20310 CHAGRIN BLVD SUITE 2
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-4913
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Country | US
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Telephone | 216-491-9405
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Fax | 216-491-9406
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Provider Business Mailing Address
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Address Line | 20310 CHAGRIN BLVD SUITE 2
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-4913
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Country | US
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Telephone | 216-491-9405
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Fax | 216-491-9406
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Authorized Official
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Title or Position | OWNER
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Name | WILLIE S WILLIAMS
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Credential | PH.D.
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Telephone | 216-491-9405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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