Provider Demographics
NPI:1922110568
Name:WILLIAMS, PAUL (PCC, LICDC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 E WILSON BRIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2365
Mailing Address - Country:US
Mailing Address - Phone:440-225-8857
Mailing Address - Fax:614-310-3320
Practice Address - Street 1:77 E WILSON BRIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2365
Practice Address - Country:US
Practice Address - Phone:440-225-8857
Practice Address - Fax:614-310-3320
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004239101YP2500X, 101YM0800X, 101YP1600X, 106H00000X
OH944129101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1922110568Medicaid