Provider Demographics
NPI:1104488527
Name:WILLIAMS, SHARON DEANTTE (LPT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:DEANTTE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:679 S NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1355
Mailing Address - Country:US
Mailing Address - Phone:626-254-5000
Mailing Address - Fax:626-294-1079
Practice Address - Street 1:1350 3RD ST
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-5299
Practice Address - Country:US
Practice Address - Phone:909-596-5921
Practice Address - Fax:909-596-7583
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
167G00000X
CA31972167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician