Provider Demographics
NPI:1366936015
Name:WILLIAMITIS, DEBRA SUE
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:SUE
Last Name:WILLIAMITIS
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 1:600 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-1122
Mailing Address - Country:US
Mailing Address - Phone:937-293-8623
Mailing Address - Fax:937-293-6489
Practice Address - Street 1:3417 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4952
Practice Address - Country:US
Practice Address - Phone:937-293-8623
Practice Address - Fax:937-293-6489
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-17
Last Update Date:2018-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health