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General NPI Number Information
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NPI Number | 1861001331
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Entity Type | Individual
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Provider Name | EDRA COLLETTE WILLIAMS LISW-S
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Gender | Female
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 55 W WATERLOO RD
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City | AKRON
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State | OH
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Zip | 44319-1116
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Country | US
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Telephone | 330-724-7715
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Fax |
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Provider Business Mailing Address
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Address Line | 2851 CASTLE VW NW
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City | UNIONTOWN
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State | OH
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Zip | 44685-5790
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Country | US
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Telephone | 330-780-8422
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1101052-SUPV
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License Number State | OH
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