Provider Demographics
NPI:1013779644
Name:WILLIAMS, LAMONT RAYNARD (MS)
Entity type:Individual
Prefix:
First Name:LAMONT
Middle Name:RAYNARD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 STONE PINE LN UNIT D
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7537
Mailing Address - Country:US
Mailing Address - Phone:916-696-1616
Mailing Address - Fax:
Practice Address - Street 1:1119 STONE PINE LN UNIT D
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-7537
Practice Address - Country:US
Practice Address - Phone:916-696-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty