Basic Information
| Provider Information | |||||||||
| NPI: | 1225331671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | VASHAUNA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5150 E PACIFIC COAST HWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908043312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624907600 | ||||||||
| FaxNumber: | 5624907601 | ||||||||
| Practice Location | |||||||||
| Address1: | 5150 E PACIFIC COAST HWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908043312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624907600 | ||||||||
| FaxNumber: | 5624907601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2010 | ||||||||
| LastUpdateDate: | 10/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF85461 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.