Provider Demographics
NPI:1710564471
Name:WILLIAMS, DANETT (LEP)
Entity Type:Individual
Prefix:
First Name:DANETT
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 22ND AVE UNIT 22284
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1659
Mailing Address - Country:US
Mailing Address - Phone:559-312-3997
Mailing Address - Fax:
Practice Address - Street 1:983 E BUCKHILL RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0771
Practice Address - Country:US
Practice Address - Phone:650-516-6028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4112103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool