Healthcare Provider Details

I. General information

NPI: 1447537303
Provider Name (Legal Business Name): ESHAWN DESHELLE WILLIAMS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20620 LEAPWOOD AVE STE B
CARSON CA
90746-3678
US

IV. Provider business mailing address

20620 S. LEAPWOOD AVE. SUITE B
CARSON CA
90746
US

V. Phone/Fax

Practice location:
  • Phone: 562-290-7331
  • Fax:
Mailing address:
  • Phone: 562-290-7331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY24636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: