Provider Demographics
NPI:1821566175
Name:WILLIAMS, ANTHONY
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 KENNETH DR
Mailing Address - Street 2:
Mailing Address - City:ROOTSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44272-9252
Mailing Address - Country:US
Mailing Address - Phone:330-850-5141
Mailing Address - Fax:330-850-5349
Practice Address - Street 1:1735 S HAWKINS AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-3902
Practice Address - Country:US
Practice Address - Phone:330-867-5400
Practice Address - Fax:330-869-8263
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00693172V00000X
OHAPS.000693175T00000X
OHCDCA.177980101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist