Provider Demographics
NPI:1588820948
Name:WILLIAMS-FLOURNOY, DORETHA FAYE (N/A)
Entity Type:Individual
Prefix:MS
First Name:DORETHA
Middle Name:FAYE
Last Name:WILLIAMS-FLOURNOY
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:MS
Other - First Name:DORETHA
Other - Middle Name:FAYE
Other - Last Name:FLOURNOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:1133 COLOMA WAY STE C
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4480
Mailing Address - Country:US
Mailing Address - Phone:916-774-6647
Mailing Address - Fax:916-774-6456
Practice Address - Street 1:1133 COLOMA WAY STE C
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4480
Practice Address - Country:US
Practice Address - Phone:916-774-6647
Practice Address - Fax:916-774-6456
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)