Provider Demographics
NPI:1184653784
Name:WILLIAMS, REBECCA E (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 MISSION GORGE PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4106
Mailing Address - Country:US
Mailing Address - Phone:619-228-8002
Mailing Address - Fax:619-228-8031
Practice Address - Street 1:4525 MISSION GORGE PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4106
Practice Address - Country:US
Practice Address - Phone:619-228-8002
Practice Address - Fax:619-228-8031
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical