Organization
IVORY PARK PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZAHARA WILLIAMS LCSW (CHIEF EXECUTIVE OFFICER)
(469) 634-0050
Entity
Organization
Contact information
Practice address
3824 CEDAR SPRINGS RD # 153, DALLAS, TX 75219-4136
(469) 634-0050
Mailing address
3824 CEDAR SPRINGS RD # 153, DALLAS, TX 75219-4136
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548406689
—
GA
05
—
1639461106
—
CA
Enumeration date
04/01/2021
Last updated
04/01/2021
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