Healthcare Provider Details

I. General information

NPI: 1528001070
Provider Name (Legal Business Name): ORLANDO I WILLIAMS LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 RIO VISTA ST
FALLON NV
89406-5463
US

IV. Provider business mailing address

PO BOX 1980
FALLON NV
89407-1980
US

V. Phone/Fax

Practice location:
  • Phone: 775-423-3634
  • Fax:
Mailing address:
  • Phone: 775-423-3634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLADC902-L
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: