Provider Demographics
NPI:1457853004
Name:WILLIAMS, DESIREE D
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:D
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 1:409 N COOPER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-2409
Mailing Address - Country:US
Mailing Address - Phone:714-554-1152
Mailing Address - Fax:714-265-4870
Practice Address - Street 1:409 N COOPER ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2409
Practice Address - Country:US
Practice Address - Phone:714-554-1152
Practice Address - Fax:714-265-4870
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA020010715101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherDRUG & ALCOHOL RESIDENTIAL FACILITY