Provider Demographics
NPI:1699325076
Name:WILLIAMSON, DESERAY
Entity type:Individual
Prefix:
First Name:DESERAY
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESERAY
Other - Middle Name:
Other - Last Name:ADCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1142 WILLAGILLESPIE RD # 9
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2142
Mailing Address - Country:US
Mailing Address - Phone:541-666-3652
Mailing Address - Fax:
Practice Address - Street 1:1142 WILLAGILLESPIE RD # 9
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2142
Practice Address - Country:US
Practice Address - Phone:541-666-3652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician