Provider Demographics
NPI:1881357218
Name:WILLIAMS, DIANNE
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 TILLMAN AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2248
Mailing Address - Country:US
Mailing Address - Phone:216-633-9690
Mailing Address - Fax:
Practice Address - Street 1:2026 MURRAY HILL RD STE 208
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-5960
Practice Address - Country:US
Practice Address - Phone:216-633-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Single Specialty