Provider Demographics
NPI:1013429539
Name:WILLIAMS, PEACHES TRIZONNA (BA, CAP)
Entity Type:Individual
Prefix:MS
First Name:PEACHES
Middle Name:TRIZONNA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BA, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-7012
Mailing Address - Country:US
Mailing Address - Phone:407-843-0041
Mailing Address - Fax:407-841-7078
Practice Address - Street 1:1800 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7012
Practice Address - Country:US
Practice Address - Phone:407-843-0041
Practice Address - Fax:407-841-7078
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1750349742Medicaid