Provider Demographics
NPI:1346932118
Name:WILLIAMS, ANDRE V (LAC)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:V
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5401
Mailing Address - Country:US
Mailing Address - Phone:530-870-1133
Mailing Address - Fax:
Practice Address - Street 1:254 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5401
Practice Address - Country:US
Practice Address - Phone:530-870-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19732171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist