Provider Demographics
NPI:1568810877
Name:WILLIAMS, KHADEJAH
Entity Type:Individual
Prefix:
First Name:KHADEJAH
Middle Name:
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 1:17338 INDIGO MIST CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-1986
Mailing Address - Country:US
Mailing Address - Phone:216-288-9928
Mailing Address - Fax:
Practice Address - Street 1:17338 INDIGO MIST CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-1986
Practice Address - Country:US
Practice Address - Phone:216-288-9928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health