Provider Demographics
NPI:1083935092
Name:WILLIAMS-FERNANDEZ, EVETTE NICOLASA (LMSW-IRP)
Entity Type:Individual
Prefix:MRS
First Name:EVETTE
Middle Name:NICOLASA
Last Name:WILLIAMS-FERNANDEZ
Suffix:
Gender:F
Credentials:LMSW-IRP
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 760131
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-0131
Mailing Address - Country:US
Mailing Address - Phone:210-884-3497
Mailing Address - Fax:210-675-7362
Practice Address - Street 1:7206 NORTHBLUFF CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-1708
Practice Address - Country:US
Practice Address - Phone:210-884-3497
Practice Address - Fax:210-675-7362
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35327171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator