Provider Demographics
NPI:1336755040
Name:WILLIAMS, LANA LEE
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:LEE
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 1:21220 NW JANNEY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32430-2122
Mailing Address - Country:US
Mailing Address - Phone:850-451-6353
Mailing Address - Fax:
Practice Address - Street 1:21220 NW JANNEY RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32430-2122
Practice Address - Country:US
Practice Address - Phone:850-451-6353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-135655106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst