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General NPI Number Information
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NPI Number | 1093937609
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Entity Type | Individual
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Provider Name | HENRIETTA WILLIAMS CAADAC
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1704 W MANCHESTER AVE # 205
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City | LOS ANGELES
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State | CA
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Zip | 90047-3034
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Country | US
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Telephone | 323-751-0608
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Fax | 323-751-0375
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Provider Business Mailing Address
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Address Line | 16422 S PANNES AVE
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City | COMPTON
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State | CA
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Zip | 90221-5141
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Country | US
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Telephone | 310-669-8673
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | A8356200
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License Number State | CA
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