Provider Demographics
NPI:1881113330
Name:WILLAMS, SHARA
Entity type:Individual
Prefix:
First Name:SHARA
Middle Name:
Last Name:WILLAMS
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 1:3440 E RUSSELL RD # 206
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2201
Mailing Address - Country:US
Mailing Address - Phone:702-214-4298
Mailing Address - Fax:702-214-4254
Practice Address - Street 1:3440 E RUSSELL RD
Practice Address - Street 2:#206
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120
Practice Address - Country:US
Practice Address - Phone:702-214-4298
Practice Address - Fax:702-214-4254
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst