Provider Demographics
NPI:1063229565
Name:WILLIAMS, CELISSA ANTONINETTE
Entity type:Individual
Prefix:
First Name:CELISSA
Middle Name:ANTONINETTE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 MIDWAY PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-6543
Mailing Address - Country:US
Mailing Address - Phone:214-986-4314
Mailing Address - Fax:
Practice Address - Street 1:2910 MIDWAY PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-6543
Practice Address - Country:US
Practice Address - Phone:214-986-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374700000X
TX374J00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No374700000XNursing Service Related ProvidersTechnician
No374J00000XNursing Service Related ProvidersDoula