Provider Demographics
NPI:1588903710
Name:WILLIAMS, NATESHA (CI)
Entity type:Individual
Prefix:
First Name:NATESHA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13621 PINE ARBOR TRL
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-3953
Mailing Address - Country:US
Mailing Address - Phone:210-837-2575
Mailing Address - Fax:
Practice Address - Street 1:13621 PINE ARBOR TRL
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-3953
Practice Address - Country:US
Practice Address - Phone:210-837-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19305101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)