Healthcare Provider Details

I. General information

NPI: 1023489234
Provider Name (Legal Business Name): DEREK FRANKLIN WILLIAMS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 DOUGLAS AVE SUITE 208
ALTAMONTE SPRINGS FL
32714-5206
US

IV. Provider business mailing address

PO BOX 592456
ORLANDO FL
32859-2456
US

V. Phone/Fax

Practice location:
  • Phone: 407-830-6412
  • Fax:
Mailing address:
  • Phone: 720-427-8768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: