Healthcare Provider Details

I. General information

NPI: 1639706385
Provider Name (Legal Business Name): PATRICIA JOANNE WILLIAMS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W F ST
ONTARIO CA
91762-3201
US

IV. Provider business mailing address

125 W F ST
ONTARIO CA
91762-3201
US

V. Phone/Fax

Practice location:
  • Phone: 909-986-4550
  • Fax:
Mailing address:
  • Phone: 909-986-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: