MEDICARE: LISA ANN 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	101YA0400X	Addiction (Substance Use Disorder) Counselor		KY

General Provider Information

NPI Number	:	1952542789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANN WILLIAMS

Provider Business Mailing Address
First Line	:	7221 DALTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-2232
Country	:	US
Telephone Number	:	562-988-3436
Fax Number	:	562-988-3439

Provider Business Practice Location Address
First Line	:	3505 LONG BEACH BLVD STE IF
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3907
Country	:	US
Telephone Number	:	562-988-3436
Fax Number	:	562-988-3439

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

Provider Enumeration Date	:	03/06/2009
Last Update Date	:	03/06/2009

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Directions to “ LISA ANN WILLIAMS ” Practice Location

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