Provider Demographics
NPI:1659953966
Name:WILLIAMS, PROMISE AZURE
Entity Type:Individual
Prefix:
First Name:PROMISE
Middle Name:AZURE
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 1:1406 S MILDRED ST APT 905
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1918
Mailing Address - Country:US
Mailing Address - Phone:509-654-0099
Mailing Address - Fax:
Practice Address - Street 1:6210 75TH ST W STE B100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8109
Practice Address - Country:US
Practice Address - Phone:253-345-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61159053103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst