Provider Demographics
NPI:1063702215
Name:WILLIAMS, VICKKI
Entity type:Individual
Prefix:
First Name:VICKKI
Middle Name:
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 1:19300 RINALDI ST
Mailing Address - Street 2:STE 8270
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1651
Mailing Address - Country:US
Mailing Address - Phone:562-343-5800
Mailing Address - Fax:
Practice Address - Street 1:1701 N GREEN VALLEY PKWY STE 9A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074
Practice Address - Country:US
Practice Address - Phone:702-407-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No101Y00000XBehavioral Health & Social Service ProvidersCounselor