Provider Demographics
NPI:1003939075
Name:WILLIAMSON, LINN DOUGLAS
Entity Type:Individual
Prefix:MR
First Name:LINN
Middle Name:DOUGLAS
Last Name:WILLIAMSON
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:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:CA
Mailing Address - Zip Code:95623-0704
Mailing Address - Country:US
Mailing Address - Phone:530-306-4700
Mailing Address - Fax:
Practice Address - Street 1:3091 ALHAMBRA DR STE E
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-7635
Practice Address - Country:US
Practice Address - Phone:530-306-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 022607106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist