Provider Demographics
NPI:1770043416
Name:WILLIAMS, DANTE' DE'SHAWN
Entity Type:Individual
Prefix:
First Name:DANTE'
Middle Name:DE'SHAWN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 MACARTHUR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6861
Mailing Address - Country:US
Mailing Address - Phone:504-882-8105
Mailing Address - Fax:
Practice Address - Street 1:3712 MACARTHUR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6861
Practice Address - Country:US
Practice Address - Phone:504-882-8105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1543866586OtherTRICARE
LA7279765248912Medicaid