Provider Demographics
NPI:1316617814
Name:WILLIAMS, JESSE PAUL (CDCA)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:PAUL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:MR
Other - First Name:JESSE
Other - Middle Name:PAUL
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA
Mailing Address - Street 1:749 STATE ROUTE 28 STE C
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-5046
Mailing Address - Country:US
Mailing Address - Phone:513-214-2094
Mailing Address - Fax:
Practice Address - Street 1:749 STATE ROUTE 28 STE C
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-5046
Practice Address - Country:US
Practice Address - Phone:513-214-2094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174686101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)