Provider Demographics
NPI:1386780047
Name:WILLIAMSON, DEBORAH SUE
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUE
Last Name:WILLIAMSON
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 1:419 MASON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4546
Mailing Address - Country:US
Mailing Address - Phone:707-452-9244
Mailing Address - Fax:707-452-1426
Practice Address - Street 1:419 MASON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4546
Practice Address - Country:US
Practice Address - Phone:707-452-9244
Practice Address - Fax:707-452-1426
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28328106H00000X
AZLMFT-10238106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist