Provider Demographics
NPI:1659857647
Name:WILLIAMS, LORRAINE MICHELLE (CDCA 169900)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:MICHELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CDCA 169900
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-3531
Mailing Address - Country:US
Mailing Address - Phone:419-255-4444
Mailing Address - Fax:
Practice Address - Street 1:3170 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2945
Practice Address - Country:US
Practice Address - Phone:567-316-7253
Practice Address - Fax:567-316-7232
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
101YA0400X
OHCDCA169900171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0305498Medicaid