Provider Demographics
NPI:1881258515
Name:WILLIAMS, TAYLOR DESHAWN
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DESHAWN
Last Name:WILLIAMS
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 1:7020 GROSVENOR PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4141
Mailing Address - Country:US
Mailing Address - Phone:317-250-2226
Mailing Address - Fax:
Practice Address - Street 1:7020 GROSVENOR PL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4141
Practice Address - Country:US
Practice Address - Phone:317-250-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker