Basic Information
| Provider Information | |||||||||
| NPI: | 1629423462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | |||||||||
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| Credential: | CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23950 PRADO LN | ||||||||
| Address2: | |||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923249734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095141958 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4750 PALM AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925014012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096082002 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2016 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CI07270317 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.