Provider Demographics
NPI:1164749198
Name:WILLIAMSON, ALVIN DEAN
Entity Type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:DEAN
Last Name:WILLIAMSON
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 1:3409 NAVAJO COURT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-3726
Mailing Address - Country:US
Mailing Address - Phone:469-879-3727
Mailing Address - Fax:214-375-4453
Practice Address - Street 1:3409 NAVAJO COURT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-3726
Practice Address - Country:US
Practice Address - Phone:469-879-3727
Practice Address - Fax:214-375-4453
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$Medicare PIN