Provider Demographics
NPI:1750445557
Name:WILLIAMS, EDMOND DESHAWN (MSW, QMHP)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:DESHAWN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MSW, QMHP
Other - Prefix:
Other - First Name:EDMOND
Other - Middle Name:DESHAWN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 16932
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0932
Mailing Address - Country:US
Mailing Address - Phone:503-334-9955
Mailing Address - Fax:
Practice Address - Street 1:421 SW OAK ST
Practice Address - Street 2:SUITE 520
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1817
Practice Address - Country:US
Practice Address - Phone:503-312-2116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical