Healthcare Provider Details

I. General information

NPI: 1891131496
Provider Name (Legal Business Name): DARRELL DEMETRIUS WILLIAMS LCDP, RCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 BURNETT ST
PROVIDENCE RI
02907-2527
US

IV. Provider business mailing address

78 INDIANA AVE
PROVIDENCE RI
02905-5302
US

V. Phone/Fax

Practice location:
  • Phone: 401-785-0050
  • Fax: 401-941-0089
Mailing address:
  • Phone: 401-263-2676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCDP00532
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: