Provider Demographics
NPI:1538653647
Name:WILLIAMS, RODNEY DEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:DEAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 STAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2553
Mailing Address - Country:US
Mailing Address - Phone:863-578-4640
Mailing Address - Fax:
Practice Address - Street 1:1811 STAUNTON AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2553
Practice Address - Country:US
Practice Address - Phone:863-578-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4442103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist