Provider Demographics
NPI:1578719001
Name:WILLIAMS, SHANNON DANIELLE (PSYD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:DANIELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HOSKING AVE APT 77D
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-5741
Mailing Address - Country:US
Mailing Address - Phone:626-379-7360
Mailing Address - Fax:
Practice Address - Street 1:2737 W. CECIL AVE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:83215
Practice Address - Country:US
Practice Address - Phone:661-721-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSY24121103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist