MEDICARE: ROXANNE WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1467946673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANNE WILLIAMS

Provider Business Mailing Address
First Line	:	PO BOX 881837
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90009-1837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3128 W 78TH PL # NA
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-5219
Country	:	US
Telephone Number	:	213-200-3880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	06/20/2018

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Directions to “ ROXANNE WILLIAMS ” Practice Location

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