Provider Demographics
NPI:1184124646
Name:WILLIAMS, ISABELLA ROSE
Entity type:Individual
Prefix:MISS
First Name:ISABELLA
Middle Name:ROSE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ISABELLA
Other - Middle Name:ROSE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1401 N TUSTIN AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8688
Mailing Address - Country:US
Mailing Address - Phone:714-221-6400
Mailing Address - Fax:714-221-6401
Practice Address - Street 1:1401 N TUSTIN AVE STE 225
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8688
Practice Address - Country:US
Practice Address - Phone:714-221-6400
Practice Address - Fax:714-221-6401
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health