Healthcare Provider Details

I. General information

NPI: 1730604695
Provider Name (Legal Business Name): CAMILLE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E MIRACLE STRIP PKWY STE 503
MARY ESTHER FL
32569-1991
US

IV. Provider business mailing address

350 AVON LN
MARY ESTHER FL
32569-1709
US

V. Phone/Fax

Practice location:
  • Phone: 850-374-3991
  • Fax: 855-445-0214
Mailing address:
  • Phone: 850-226-9057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-38346
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-21-12526
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: