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General NPI Number Information
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NPI Number | 1437774551
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Entity Type | Organization
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Legal Business Name | EBONIE WILLIAMS
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Dates
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Enumeration Date | 06/15/2020
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 8204 ELMBROOK DR
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City | DALLAS
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State | TX
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Zip | 75247-4067
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Country | US
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Telephone | 214-907-4773
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 CYPRESS DR
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City | ROCKWALL
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State | TX
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Zip | 75087-0319
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OF OPERATIONS
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Name | MRS. JOANETTE WOODS
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Credential |
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Telephone | 469-909-8915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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