Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CDCA.172740 | OH |
NPI | 1003309204 |
---|---|
Provider Name | James Williams |
First Address | Mansfield, OH 44903-8682 |
Second Address | Mansfield, OH 44903-8682 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2018 |
Last Update Date | 09/10/2020 |