Provider Demographics
NPI:1275904658
Name:WILLIAMSON, DESHANNON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DESHANNON
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
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:PO BOX 5645
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-0645
Mailing Address - Country:US
Mailing Address - Phone:510-501-4596
Mailing Address - Fax:
Practice Address - Street 1:1422 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542-1104
Practice Address - Country:US
Practice Address - Phone:510-501-4596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW734101041C0700X
CA390200000X1041C0700X
CA101Y00000X104100000X
CA991751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker