Provider Demographics
NPI:1144781725
Name:SANDFORD-WILLIAMS, CHARLENE (BSW)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:SANDFORD-WILLIAMS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20600 CHAGRIN BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5334
Mailing Address - Country:US
Mailing Address - Phone:216-295-7239
Mailing Address - Fax:216-295-7240
Practice Address - Street 1:20600 CHAGRIN BLVD STE 320
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5334
Practice Address - Country:US
Practice Address - Phone:216-295-7239
Practice Address - Fax:216-295-7240
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPP-00019121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker