Provider Demographics
NPI:1821623760
Name:WILLIAMS, LAWANDA JEAN (13598-R)
Entity Type:Individual
Prefix:MS
First Name:LAWANDA
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:13598-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2055
Mailing Address - Country:US
Mailing Address - Phone:626-331-5316
Mailing Address - Fax:626-332-2219
Practice Address - Street 1:4626 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2055
Practice Address - Country:US
Practice Address - Phone:626-331-5316
Practice Address - Fax:626-332-2219
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13598-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)