Provider Demographics
NPI:1124218730
Name:WILLIAMS, RUSSELL WILLIAM (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:WILLIAM
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 E ELDER ST
Mailing Address - Street 2:B
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3079
Mailing Address - Country:US
Mailing Address - Phone:760-723-7877
Mailing Address - Fax:760-723-7877
Practice Address - Street 1:577 E ELDER ST
Practice Address - Street 2:B
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3079
Practice Address - Country:US
Practice Address - Phone:760-723-7877
Practice Address - Fax:760-723-7877
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS17238101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional