Provider Demographics
NPI:1548417231
Name:WILLIAMS, EVELYN (CLINICAL DIRECTOR)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CLINICAL DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20348 E WARNER RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-9655
Mailing Address - Country:US
Mailing Address - Phone:480-751-7483
Mailing Address - Fax:480-279-3828
Practice Address - Street 1:20348 E WARNER RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-9655
Practice Address - Country:US
Practice Address - Phone:480-751-7483
Practice Address - Fax:480-279-3828
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No177F00000XOther Service ProvidersLodging
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No347C00000XTransportation ServicesPrivate Vehicle
No251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ438547Medicaid