Provider Demographics
NPI:1285272963
Name:WILLIAMS, THEOPHILUS NIKIA
Entity type:Individual
Prefix:
First Name:THEOPHILUS
Middle Name:NIKIA
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 1:3521 W 54TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-5709
Mailing Address - Country:US
Mailing Address - Phone:216-317-3630
Mailing Address - Fax:
Practice Address - Street 1:3521 W 54TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-5709
Practice Address - Country:US
Practice Address - Phone:216-317-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health