Provider Demographics
NPI:1275286155
Name:WILLIAMS, ROLAND (MAC, SAP, LAADC)
Entity Type:Individual
Prefix:MR
First Name:ROLAND
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MAC, SAP, LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14829 W ALDEA CT
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-2711
Mailing Address - Country:US
Mailing Address - Phone:415-845-1174
Mailing Address - Fax:
Practice Address - Street 1:7301 N 16TH ST STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5266
Practice Address - Country:US
Practice Address - Phone:415-845-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALR01450315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)