Provider Demographics
NPI:1659857316
Name:WILLIAMS, CERMILLIA LAVONE (MBA, MSW)
Entity type:Individual
Prefix:MISS
First Name:CERMILLIA
Middle Name:LAVONE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MBA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 E BROADWAY RD UNIT 29
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-1748
Mailing Address - Country:US
Mailing Address - Phone:314-494-7603
Mailing Address - Fax:
Practice Address - Street 1:2655 W GUADALUPE RD STE 7
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7246
Practice Address - Country:US
Practice Address - Phone:314-494-7603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YP2500X, 104100000X, 1041C0700X, 106H00000X, 171M00000X, 175T00000X, 261QR0405X, 372500000X, 374U00000X, 376J00000X, 101YM0800X
AZCHW0000000455172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Yes172V00000XOther Service ProvidersCommunity Health Worker