Provider Demographics
NPI:1275221152
Name:WILLIAMS, DALLAS RAEANNE
Entity Type:Individual
Prefix:
First Name:DALLAS
Middle Name:RAEANNE
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 1:822 S OAKDALE AVE APT A
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3561
Mailing Address - Country:US
Mailing Address - Phone:541-613-5750
Mailing Address - Fax:
Practice Address - Street 1:822 S OAKDALE AVE APT A
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3561
Practice Address - Country:US
Practice Address - Phone:541-613-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health