Individual
THERON ULYSSES WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
630 HAINES AVE NW, ALBUQUERQUE, NM 87102-1226
(505) 268-5611
(505) 268-5736
Mailing address
630 HAINES AVE NW, ALBUQUERQUE, NM 87102-1226
(505) 268-5611
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CTB-2024-0336
NM
171M00000X
Case Manager/Care Coordinator
—
UT
Other
Enumeration date
08/24/2020
Last updated
06/14/2024
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