Provider Demographics
NPI:1518679984
Name:WILLIAMS, CARLA DEANNA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:DEANNA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11558 FREMANTLE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-2636
Mailing Address - Country:US
Mailing Address - Phone:513-405-4674
Mailing Address - Fax:
Practice Address - Street 1:11558 FREMANTLE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-2636
Practice Address - Country:US
Practice Address - Phone:513-405-4674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X
OH261QD1600X
OH3058628405300000X
OH22287064385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251V00000XAgenciesVoluntary or Charitable
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3124812Medicaid