Provider Demographics
NPI:1194016139
Name:WILLIAMS, DOLORES LYNAL (LCSW)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:LYNAL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5179 LONE TREE WAY
Mailing Address - Street 2:SUITE 509
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8689
Mailing Address - Country:US
Mailing Address - Phone:707-474-8885
Mailing Address - Fax:
Practice Address - Street 1:5179 LONE TREE WAY
Practice Address - Street 2:SUITE 509
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8689
Practice Address - Country:US
Practice Address - Phone:707-474-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical