Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 15492 | FL |
NPI | 1114275195 |
---|---|
Provider Name | Mr. Desmond Charles Williams |
First Address | Cutler Bay, FL 33157-7652 |
Second Address | Homestead, FL 33033-4533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2012 |
Last Update Date | 21/08/2012 |