Provider Demographics
NPI:1861035347
Name:WILLIAMS, SERENA RAE (CLC, CD)
Entity Type:Individual
Prefix:MRS
First Name:SERENA
Middle Name:RAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CLC, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 CARLISLE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-2737
Mailing Address - Country:US
Mailing Address - Phone:937-522-1816
Mailing Address - Fax:
Practice Address - Street 1:622 CARLISLE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-2737
Practice Address - Country:US
Practice Address - Phone:937-522-1816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2022-08-11
Deactivation Date:2021-11-02
Deactivation Code:
Reactivation Date:2022-08-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty