Provider Demographics
NPI:1851454235
Name:WILLIAMS, LORA LYNN
Entity type:Individual
Prefix:MS
First Name:LORA
Middle Name:LYNN
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 1:1005 MILLERTON DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-5426
Mailing Address - Country:US
Mailing Address - Phone:937-435-4505
Mailing Address - Fax:
Practice Address - Street 1:42 E RAHN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5462
Practice Address - Country:US
Practice Address - Phone:937-728-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0500685101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health