MEDICARE: ALISSA WILLIAMS CDCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	151627	OH

General Provider Information

NPI Number	:	1609318518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISSA WILLIAMS CDCA

Provider Business Mailing Address
First Line	:	69 KELLY CT
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-6024
Country	:	US
Telephone Number	:	513-941-4999
Fax Number	:	513-941-7555

Provider Business Practice Location Address
First Line	:	7597 BRIDGETOWN RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-2019
Country	:	US
Telephone Number	:	513-941-4999
Fax Number	:	513-941-7555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2016
Last Update Date	:	11/09/2016

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