Provider Demographics
NPI:1396509519
Name:WILLIAMS, CHARLES WESLEY (CDCA II)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:WESLEY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CDCA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15825 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-1052
Mailing Address - Country:US
Mailing Address - Phone:216-526-8346
Mailing Address - Fax:800-856-4265
Practice Address - Street 1:15825 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-1052
Practice Address - Country:US
Practice Address - Phone:216-526-8346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.178150101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)