Provider Demographics
NPI:1215264577
Name:WILLIAMS, DAVIANNA I
Entity type:Individual
Prefix:MS
First Name:DAVIANNA
Middle Name:I
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 1:400 S LA BREA AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-2339
Mailing Address - Country:US
Mailing Address - Phone:310-674-6267
Mailing Address - Fax:310-673-5904
Practice Address - Street 1:400 S LA BREA AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2339
Practice Address - Country:US
Practice Address - Phone:310-674-6267
Practice Address - Fax:310-673-5904
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)