Provider Demographics
NPI:1942957378
Name:WILLIAMS, KALANI MICHELE
Entity Type:Individual
Prefix:MISS
First Name:KALANI
Middle Name:MICHELE
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 1:10089 RIVER PARK CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4181
Mailing Address - Country:US
Mailing Address - Phone:209-687-2488
Mailing Address - Fax:
Practice Address - Street 1:10089 RIVER PARK CIR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4181
Practice Address - Country:US
Practice Address - Phone:209-687-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-05
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health