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General NPI Number Information
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NPI Number | 1114275195
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Entity Type | Individual
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Provider Name | MR. DESMOND CHARLES WILLIAMS
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Gender | Male
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 4175 NE 11TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33033-4533
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Country | US
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Telephone | 786-425-7883
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Fax |
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Provider Business Mailing Address
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Address Line | 10675 SW 190TH ST 1201
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City | CUTLER BAY
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State | FL
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Zip | 33157-7652
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Country | US
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Telephone | 786-425-7883
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 15492
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License Number State | FL
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