Provider Demographics
NPI:1073768701
Name:WILLIAMS, JOHNNY L
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:L
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 1:959 N LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-2207
Mailing Address - Country:US
Mailing Address - Phone:310-677-1222
Mailing Address - Fax:310-677-1199
Practice Address - Street 1:959 N LA BREA AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-2207
Practice Address - Country:US
Practice Address - Phone:310-677-1222
Practice Address - Fax:310-677-1199
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)