Active NPI
Jacqueline Vernade Willis, LCDC II
- Addiction (Substance Use Disorder) Counselor
- Akron, OH
National Provider Identifier
1477938223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 162419
- Practice address
- 725 E Market St
Akron, OH 44305-2421 - Phone
- (330) 434-4141
- NPI assigned
- Jul 22, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 162419 | OH | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 162419 | OH | Primary |
Addresses
Primary practice location
725 E Market St
Akron, OH 44305-2421
Mailing address
615 Elsinore PL Ste 200
Cincinnati, OH 45202-1457
Phone (833) 510-4357
Other practice location 1
999 N Main St
Akron, OH 44310-1456
Phone (833) 510-4357
Other practice location 2
3135 Euclid Ave
Cleveland, OH 44115-2531
Phone (216) 391-2064 ext. 30
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 162419 | OH | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Drug Board, Inc | Community/Behavioral Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712102400000",
"number": "1477938223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 ELSINORE PL STE 200",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452021457",
"telephone_number": "833-510-4357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 E MARKET ST",
"city": "AKRON",
"state": "OH",
"postal_code": "443052421",
"telephone_number": "330-434-4141"
}
],
"practiceLocations": [
{
"address_1": "999 N Main St",
"address_purpose": "LOCATION",
"city": "Akron",
"state": "OH",
"postal_code": "443101456",
"country_code": "US",
"telephone_number": "833-510-4357",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3135 Euclid Ave",
"address_purpose": "LOCATION",
"city": "Cleveland",
"state": "OH",
"postal_code": "441152531",
"country_code": "US",
"telephone_number": "216-391-2064 x30",
"fax_number": "216-431-7189",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILLIS",
"first_name": "JACQUELINE",
"middle_name": "VERNADE",
"credential": "LCDC II",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-22",
"last_updated": "2024-04-03",
"certification_date": "2024-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "OH",
"license": "162419",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "162419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Akron, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.