Healthcare Provider Details

I. General information

NPI: 1073679627
Provider Name (Legal Business Name): JOSEPHINE ANN WILLIAMS ICADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W LINN ST
NORMAN OK
73069-5837
US

IV. Provider business mailing address

1114 MCGEE DR APT A
NORMAN OK
73069-4119
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-0022
  • Fax: 405-360-4918
Mailing address:
  • Phone: 405-321-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberICADC 263
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: