Provider Demographics
NPI:1164127148
Name:WILLIAMS, CHAKILA Y
Entity Type:Individual
Prefix:
First Name:CHAKILA
Middle Name:Y
Last Name:WILLIAMS
Suffix:
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 1:111 GOLDEN ISLES DR APT B7
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5802
Mailing Address - Country:US
Mailing Address - Phone:954-305-4146
Mailing Address - Fax:
Practice Address - Street 1:111 GOLDEN ISLES DR APT B7
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5802
Practice Address - Country:US
Practice Address - Phone:954-305-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB814628106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician