Provider Demographics
NPI:1316536147
Name:WILLIAMS, DOMONIQUE NACHET (MA)
Entity type:Individual
Prefix:
First Name:DOMONIQUE
Middle Name:NACHET
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 WRIGHT PL STE 200
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-6583
Mailing Address - Country:US
Mailing Address - Phone:760-283-7372
Mailing Address - Fax:877-973-9238
Practice Address - Street 1:1902 WRIGHT PL STE 200
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-6583
Practice Address - Country:US
Practice Address - Phone:760-283-7372
Practice Address - Fax:877-973-9238
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst