Provider Demographics
NPI:1376876821
Name:WILLIAMS, DAVIN (LPC)
Entity Type:Individual
Prefix:
First Name:DAVIN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COLUMBUS AVE
Mailing Address - Street 2:PATIENT ACCOUNTS
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1233
Mailing Address - Country:US
Mailing Address - Phone:203-503-3174
Mailing Address - Fax:203-503-3174
Practice Address - Street 1:360 COLUMBUS AVE
Practice Address - Street 2:SCHOOL BASE CLINIC
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1516
Practice Address - Country:US
Practice Address - Phone:475-220-7619
Practice Address - Fax:475-220-7618
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid