Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 8201-S | NV |
Y | 1041C0700X | Clinical Social Worker | IC-1390 | NV |
NPI | 1003473422 |
---|---|
Provider Name | Rachel Mabuta Williams |
First Address | Las Vegas, NV 89118-1440 |
Second Address | Las Vegas, NV 89106-4165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2019 |
Last Update Date | 08/11/2019 |