Provider Demographics
NPI:1699012898
Name:WILLIAMS, ANDRE
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
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 1:11051 AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-3309
Mailing Address - Country:US
Mailing Address - Phone:702-437-2727
Mailing Address - Fax:702-437-1584
Practice Address - Street 1:11051 AUTUMN LN
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-3309
Practice Address - Country:US
Practice Address - Phone:702-437-2727
Practice Address - Fax:702-437-1584
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP1205101Y00000X
OHE.200.1900101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor