Provider Demographics
NPI:1760615223
Name:WILLIAMS, ANGELA LYNN (LPCC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LYNN
Other - Last Name:WISLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:625 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1805
Mailing Address - Country:US
Mailing Address - Phone:330-455-0374
Mailing Address - Fax:330-453-6716
Practice Address - Street 1:601 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1836
Practice Address - Country:US
Practice Address - Phone:330-455-0374
Practice Address - Fax:330-453-6716
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0800365101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0214416Medicaid
OH0290822Medicaid