Provider Demographics
NPI:1760039101
Name:GOODWIN-WILLIAMS, KATHY ANN (CDCA, QBHS)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:GOODWIN-WILLIAMS
Suffix:
Gender:F
Credentials:CDCA, QBHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1256 SHEPHERD LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2408
Mailing Address - Country:US
Mailing Address - Phone:513-300-0712
Mailing Address - Fax:
Practice Address - Street 1:5726 SOUTHWYCK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1510
Practice Address - Country:US
Practice Address - Phone:419-865-5690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.170504251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health