Provider Demographics
NPI:1114275195
Name:WILLIAMS, DESMOND CHARLES
Entity Type:Individual
Prefix:MR
First Name:DESMOND
Middle Name:CHARLES
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 1:10675 SW 190TH ST
Mailing Address - Street 2:1201
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7652
Mailing Address - Country:US
Mailing Address - Phone:786-425-7883
Mailing Address - Fax:
Practice Address - Street 1:4175 NE 11TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4533
Practice Address - Country:US
Practice Address - Phone:786-425-7883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15492101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral