Provider Demographics
NPI:1326635582
Name:WILLIAMS, LATEANARA SHONTE
Entity Type:Individual
Prefix:MS
First Name:LATEANARA
Middle Name:SHONTE
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 1:2170 GUNDRY AVE APT 212
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-3574
Mailing Address - Country:US
Mailing Address - Phone:323-237-0455
Mailing Address - Fax:
Practice Address - Street 1:2170 GUNDRY AVE APT 1
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-3571
Practice Address - Country:US
Practice Address - Phone:323-237-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician