Provider Demographics
NPI:1801399076
Name:WILLIAMS, D'ANDREA RUTH
Entity Type:Individual
Prefix:
First Name:D'ANDREA
Middle Name:RUTH
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 1:5109 MOON LILY WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-4358
Mailing Address - Country:US
Mailing Address - Phone:916-504-8455
Mailing Address - Fax:
Practice Address - Street 1:10305 PROMENADE PKWY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-9400
Practice Address - Country:US
Practice Address - Phone:916-544-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician