Provider Demographics
NPI:1184189623
Name:WILLIAMS, LEVI JOHN
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:JOHN
Last Name:WILLIAMS
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 1:1801 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-4321
Mailing Address - Country:US
Mailing Address - Phone:714-245-0045
Mailing Address - Fax:
Practice Address - Street 1:1801 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-4321
Practice Address - Country:US
Practice Address - Phone:714-433-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2023-11-15
Deactivation Date:2019-02-08
Deactivation Code:
Reactivation Date:2019-02-15
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA1190401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health