Provider Demographics
NPI:1497248777
Name:WILLIMS-LATTIEMORE, CHRISTINE D (CDCA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:D
Last Name:WILLIMS-LATTIEMORE
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 ANSEL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3323
Mailing Address - Country:US
Mailing Address - Phone:216-421-0662
Mailing Address - Fax:
Practice Address - Street 1:1227 ANSEL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3323
Practice Address - Country:US
Practice Address - Phone:216-421-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OH165064101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)