Provider Demographics
NPI:1881356103
Name:WILLIAMS, SHANICE
Entity type:Individual
Prefix:
First Name:SHANICE
Middle Name:
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 1:60 N PECOS RD APT 2160
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-4850
Mailing Address - Country:US
Mailing Address - Phone:951-334-3012
Mailing Address - Fax:
Practice Address - Street 1:914 E SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3004
Practice Address - Country:US
Practice Address - Phone:702-609-7212
Practice Address - Fax:702-659-6910
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst