Healthcare Provider Details

I. General information

NPI: 1679995963
Provider Name (Legal Business Name): TAKISHA WILLIAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11776 MARIPOSA RD
HESPERIA CA
92345-1622
US

IV. Provider business mailing address

13263 MONTE LARGO LN
VICTORVILLE CA
92394-0556
US

V. Phone/Fax

Practice location:
  • Phone: 760-956-2462
  • Fax:
Mailing address:
  • Phone: 760-586-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number142248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: