Provider Demographics
NPI:1659045920
Name:WILLIAMS, BIANCA (QMHA, PWS)
Entity type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:QMHA, PWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 ANDERSON AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-4641
Mailing Address - Country:US
Mailing Address - Phone:530-526-5644
Mailing Address - Fax:
Practice Address - Street 1:833 ANDERSON AVE STE 6
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-4641
Practice Address - Country:US
Practice Address - Phone:530-526-5644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000105206175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist