Provider Demographics
NPI:1285029819
Name:WILLIAMS, STEFANIE (RADT-I)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 W CLOVER ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3010
Mailing Address - Country:US
Mailing Address - Phone:530-402-5576
Mailing Address - Fax:
Practice Address - Street 1:8 W CLOVER ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3010
Practice Address - Country:US
Practice Address - Phone:530-402-5576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR117771214324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility