MEDICARE: MS. CHRISTINA LEE WILLIAMS MS, BCBA

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	103K00000X	Behavior Analyst	1-13-12857	FL

General Provider Information

NPI Number	:	1720222730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINA LEE WILLIAMS MS, BCBA

Provider Business Mailing Address
First Line	:	PO BOX 290272
Second Line	:	PO BOX 290272
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-0272
Country	:	US
Telephone Number	:	386-383-2665
Fax Number	:

Provider Business Practice Location Address
First Line	:	1176 PELICAN BAY DR
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1381
Country	:	US
Telephone Number	:	386-383-2665
Fax Number	:

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

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	09/17/2014

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