Provider Demographics
NPI:1295398188
Name:WILLIAMS, ERIC D'WAYNE
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:D'WAYNE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-3434
Mailing Address - Country:US
Mailing Address - Phone:510-692-5637
Mailing Address - Fax:
Practice Address - Street 1:4321 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-3434
Practice Address - Country:US
Practice Address - Phone:510-692-5637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician