Provider Demographics
NPI:1124449426
Name:WILLIAMS, CARMON NACOLE
Entity type:Individual
Prefix:
First Name:CARMON
Middle Name:NACOLE
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 1:23638 NEWHALL AVE
Mailing Address - Street 2:#6 424
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321
Mailing Address - Country:US
Mailing Address - Phone:310-882-8121
Mailing Address - Fax:
Practice Address - Street 1:400 CORPORATE POINTE
Practice Address - Street 2:300
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7615
Practice Address - Country:US
Practice Address - Phone:310-882-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-04
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1116461041C0700X, 1041C0700X
CA309731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical