Basic Information
| Provider Information | |||||||||
| NPI: | 1851883185 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | ANTONETTE | ||||||||
| MiddleName: | |||||||||
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| Credential: | B.A. SOCIAL SCIENCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1229 PIUTE ST | ||||||||
| Address2: | |||||||||
| City: | BARSTOW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923115455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604475654 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8350 ARCHIBALD AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917303670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004348923 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2018 | ||||||||
| LastUpdateDate: | 05/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | CA | Y | 101Y00000X | CA | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.