Provider Demographics
NPI:1114662087
Name:WILLIAMS, EBONY ALICIA JR
Entity Type:Individual
Prefix:MS
First Name:EBONY
Middle Name:ALICIA
Last Name:WILLIAMS
Suffix:JR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1208
Mailing Address - Country:US
Mailing Address - Phone:786-504-6268
Mailing Address - Fax:
Practice Address - Street 1:2670 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1208
Practice Address - Country:US
Practice Address - Phone:786-504-6263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician