MEDICARE: SHANON WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1649584392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANON WILLIAMS

Provider Business Mailing Address
First Line	:	1841 W IMPERIAL HWY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-5021
Country	:	US
Telephone Number	:	323-750-2850
Fax Number	:	323-750-0851

Provider Business Practice Location Address
First Line	:	1841 W IMPERIAL HWY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-5021
Country	:	US
Telephone Number	:	323-750-2850
Fax Number	:	323-750-0851

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	08/04/2010

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Directions to “ SHANON WILLIAMS ” Practice Location

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