Provider Demographics
NPI:1154312239
Name:WILLIAMS, AVA JEAN (MS, BCPC)
Entity Type:Individual
Prefix:MRS
First Name:AVA
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 FRANKLIN BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1839
Mailing Address - Country:US
Mailing Address - Phone:916-422-8862
Mailing Address - Fax:916-422-2050
Practice Address - Street 1:7000 FRANKLIN BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1839
Practice Address - Country:US
Practice Address - Phone:916-422-8862
Practice Address - Fax:916-422-2050
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV797P-7015AOtherFEDERAL - GSA/VA FSS