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General NPI Number Information
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NPI Number | 1275904658
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Entity Type | Individual
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Provider Name | DESHANNON WILLIAMSON LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 1422 HIGHLAND BLVD
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City | HAYWARD
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State | CA
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Zip | 94542-1104
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Country | US
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Telephone | 510-501-4596
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5645
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City | OAKLAND
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State | CA
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Zip | 94605-0645
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Country | US
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Telephone | 510-501-4596
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW73410
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 390200000X
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 101Y00000X
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 99175
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License Number State | CA
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