Provider Demographics
NPI:1972939155
Name:WILLIAMS, DONALD MILES JR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:MILES
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 9TH ST # 122
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-6039
Mailing Address - Country:US
Mailing Address - Phone:831-884-2341
Mailing Address - Fax:
Practice Address - Street 1:201 9TH ST # 122
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-6039
Practice Address - Country:US
Practice Address - Phone:831-884-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010940051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical