Provider Demographics
NPI:1003542218
Name:WILLIAMS, TREVAUGHN J
Entity Type:Individual
Prefix:
First Name:TREVAUGHN
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-9502
Mailing Address - Country:US
Mailing Address - Phone:407-383-4044
Mailing Address - Fax:
Practice Address - Street 1:2412 BEACH AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-9502
Practice Address - Country:US
Practice Address - Phone:407-383-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker