Provider Demographics
NPI:1518579101
Name:WILLIAMS, ELLIOT CARSON (LSW)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:CARSON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:ELIZABETH
Other - Last Name:RUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1347 KENILWORTH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3144
Mailing Address - Country:US
Mailing Address - Phone:330-388-6014
Mailing Address - Fax:
Practice Address - Street 1:3500 LORAIN AVE STE 300
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3726
Practice Address - Country:US
Practice Address - Phone:216-250-1607
Practice Address - Fax:216-304-6669
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.23091861041C0700X
OHCDCA.172803101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)