Provider Demographics
NPI:1689898918
Name:WILLIAMSON, FLORENCE JANE
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:JANE
Last Name:WILLIAMSON
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 1:4540 PANORAMA DRIVE,
Mailing Address - Street 2:P.O. BOX 704
Mailing Address - City:EL DORADO
Mailing Address - State:CA
Mailing Address - Zip Code:95623
Mailing Address - Country:US
Mailing Address - Phone:530-642-2412
Mailing Address - Fax:
Practice Address - Street 1:2808 MALLARD LANE
Practice Address - Street 2:SUITE C
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667
Practice Address - Country:US
Practice Address - Phone:530-621-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT32579106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist