MEDICARE: ANDRIONNA L WILLIAMS BA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist
3	106H00000X	Marriage & Family Therapist
4	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1811262488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRIONNA L WILLIAMS BA

Provider Business Mailing Address
First Line	:	3717 KING CHARLES ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4422
Country	:	US
Telephone Number	:	702-808-1261
Fax Number	:

Provider Business Practice Location Address
First Line	:	3053 W CRAIG RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5124
Country	:	US
Telephone Number	:	702-808-1261
Fax Number	:

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

Provider Enumeration Date	:	03/15/2012
Last Update Date	:	03/15/2012

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