Provider Demographics
NPI:1346500212
Name:WILLIAMS, RONNETTA (PHD)
Entity Type:Individual
Prefix:
First Name:RONNETTA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N STATE ROAD 19 STE 48
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-2449
Mailing Address - Country:US
Mailing Address - Phone:352-281-9574
Mailing Address - Fax:
Practice Address - Street 1:400 N STATE ROAD 19 STE 48
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-2449
Practice Address - Country:US
Practice Address - Phone:352-281-9574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009093103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071.009093OtherPROFESSIONAL LICENSE NUMBER