Individual
BRYAN ANTOINE WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12450 VAN NUYS BLVD, SUITE 200, PACOIMA, CA 91331-1391
(818) 896-1161
Mailing address
12450 VAN NUYS BLVD, SUITE 200, PACOIMA, CA 91331-1391
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6758
—
CA
05
—
7068
—
CA
Enumeration date
05/05/2011
Last updated
05/13/2013
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