Provider Demographics
NPI:1801933551
Name:WILLIAMS, SHARON (CGACII NCGCII CADCI)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CGACII NCGCII CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3668 FISHER RD NE
Mailing Address - Street 2:APT 159
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-5122
Mailing Address - Country:US
Mailing Address - Phone:503-540-5563
Mailing Address - Fax:503-316-9740
Practice Address - Street 1:3321 HAROLD DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1339
Practice Address - Country:US
Practice Address - Phone:503-540-5563
Practice Address - Fax:503-316-9740
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR02-11-91101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator