Provider Demographics
NPI:1689862716
Name:WILLIAMS, TARI LYNN (CAS)
Entity Type:Individual
Prefix:MRS
First Name:TARI
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4990 WILLIAMS AVENUE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941
Mailing Address - Country:US
Mailing Address - Phone:619-668-4216
Mailing Address - Fax:619-698-1665
Practice Address - Street 1:3513 PASEO DE COLOMBO UNIT 45
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4146
Practice Address - Country:US
Practice Address - Phone:619-668-4216
Practice Address - Fax:619-698-1665
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01034491101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)