Provider Demographics
NPI:1770216822
Name:WILLIAMS, GABRIELLA NICOLE
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:NICOLE
Last Name:WILLIAMS
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 1:611 GATEWAY BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:S SAN FRAN
Mailing Address - State:CA
Mailing Address - Zip Code:94080-7066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 GATEWAY BLVD STE 160
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-7066
Practice Address - Country:US
Practice Address - Phone:954-980-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-222824106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician