Provider Demographics
NPI:1902373830
Name:WILLIAMS, JOSEPH LEEON (CDPT #60749539)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEEON
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CDPT #60749539
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99818
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-0818
Mailing Address - Country:US
Mailing Address - Phone:253-473-7474
Mailing Address - Fax:253-473-9725
Practice Address - Street 1:4928 109TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3731
Practice Address - Country:US
Practice Address - Phone:253-473-7474
Practice Address - Fax:253-473-9724
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60749539101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)