Provider Demographics
NPI:1700186756
Name:WILLIAMS, MONIQUE FULLARD (MA)
Entity Type:Individual
Prefix:MISS
First Name:MONIQUE
Middle Name:FULLARD
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N A ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-0612
Mailing Address - Country:US
Mailing Address - Phone:916-440-1500
Mailing Address - Fax:916-440-1512
Practice Address - Street 1:1400 N A ST BLDG A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-0612
Practice Address - Country:US
Practice Address - Phone:916-440-1500
Practice Address - Fax:916-440-1512
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator