Provider Demographics
NPI:1831837236
Name:WILLIAMS, QUIANA L (CO 61035522)
Entity type:Individual
Prefix:
First Name:QUIANA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CO 61035522
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 NE RIDDELL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3005
Mailing Address - Country:US
Mailing Address - Phone:360-228-7246
Mailing Address - Fax:
Practice Address - Street 1:5120 NE RIDDELL ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310
Practice Address - Country:US
Practice Address - Phone:360-228-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61035522101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)