Provider Demographics
NPI:1770700775
Name:DEFELICE, WILLIAM (LPCC AND LICDC-CS)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:DEFELICE
Suffix:
Gender:M
Credentials:LPCC AND LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 WEST 25TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109
Mailing Address - Country:US
Mailing Address - Phone:216-459-1222
Mailing Address - Fax:216-651-1096
Practice Address - Street 1:1891 FULTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113
Practice Address - Country:US
Practice Address - Phone:216-651-0234
Practice Address - Fax:216-651-1096
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH975961101YA0400X
OHE0002866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000334427OtherANTHEM
OH1000683OtherQUAL CHOICE
OH215952000OtherMAGELLAN
OH0193123Medicaid
OH7649640OtherAETNA
OH2038292OtherCIGNA