Provider Demographics
NPI:1194499764
Name:WILLIAMS, STEPHANIE LORRAINE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LORRAINE
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 1:14804 N CAVE CREEK RD # 212
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4945
Mailing Address - Country:US
Mailing Address - Phone:602-330-1594
Mailing Address - Fax:602-585-0611
Practice Address - Street 1:14804 N CAVE CREEK RD # 212
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4945
Practice Address - Country:US
Practice Address - Phone:602-330-1594
Practice Address - Fax:602-585-0611
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst