Provider Demographics
NPI:1477712941
Name:WILLIAMS, GLORIA JEANNE (CDP)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:JEANNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1678
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668-1678
Mailing Address - Country:US
Mailing Address - Phone:360-397-4286
Mailing Address - Fax:360-397-8450
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3753
Practice Address - Country:US
Practice Address - Phone:360-397-4286
Practice Address - Fax:360-397-8450
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60026470172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC00055291OtherCHEMICAL DEPENDENCY PROFESSIONAL
WARC00055291OtherCHEMICAL DEPENDENCY PROFESSIONAL