Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225C00000X | Rehabilitation Counselor | CA |
NPI | 1184247546 |
---|---|
Provider Name | Shannan Williams |
First Address | San Diego, CA 92108-1709 |
Second Address | San Diego, CA 92108-1709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2020 |
Last Update Date | 20/05/2020 |