Provider Demographics
NPI:1447722442
Name:WILLIAMS, DEMETRA L
Entity type:Individual
Prefix:
First Name:DEMETRA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 CEDAR VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-2306
Mailing Address - Country:US
Mailing Address - Phone:214-558-0236
Mailing Address - Fax:
Practice Address - Street 1:2026 CEDAR VALLEY LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-2306
Practice Address - Country:US
Practice Address - Phone:214-558-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator