Provider Demographics
NPI:1730636333
Name:WILLIAMS, JOHNNY (LPCC)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 NORTHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4917
Mailing Address - Country:US
Mailing Address - Phone:513-429-4443
Mailing Address - Fax:
Practice Address - Street 1:260 NORTHLAND BLVD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4917
Practice Address - Country:US
Practice Address - Phone:513-429-4443
Practice Address - Fax:513-429-5559
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0500322101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional