Provider Demographics
NPI:1497300339
Name:WILLIAMSON, IAN CHRISTIAN (CADCI)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:CHRISTIAN
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:CADCI
Other - Prefix:
Other - First Name:IAN
Other - Middle Name:CHRISTIAN
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADCI
Mailing Address - Street 1:6655 W SAHARA AVE STE D208
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0851
Mailing Address - Country:US
Mailing Address - Phone:702-275-3126
Mailing Address - Fax:
Practice Address - Street 1:6655 W SAHARA AVE STE D208
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0851
Practice Address - Country:US
Practice Address - Phone:702-275-3126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV02519-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV02519-IOtherSUBSTANCE ABUSE