Provider Demographics
NPI:1891933735
Name:WILLIAMS, IESHA S (CASAC)
Entity Type:Individual
Prefix:MRS
First Name:IESHA
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 METROPOLITAN OVAL APT 2C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6548
Mailing Address - Country:US
Mailing Address - Phone:347-621-4245
Mailing Address - Fax:347-621-4245
Practice Address - Street 1:7 METROPOLITAN OVAL APT 2C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6548
Practice Address - Country:US
Practice Address - Phone:347-621-4245
Practice Address - Fax:347-621-4245
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16711101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)