Provider Demographics
NPI:1043563067
Name:ROMAN, WILLIAM KRISTOPHER (MA LPC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KRISTOPHER
Last Name:ROMAN
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 CHRISTIE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606
Mailing Address - Country:US
Mailing Address - Phone:419-344-3671
Mailing Address - Fax:
Practice Address - Street 1:8336 MONROE RD RM 120
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9340
Practice Address - Country:US
Practice Address - Phone:734-807-0162
Practice Address - Fax:734-224-7872
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1100264101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional