Provider Demographics
NPI:1053707786
Name:WILLIAMS, TAKESHIA VERNICE (PHD)
Entity type:Individual
Prefix:DR
First Name:TAKESHIA
Middle Name:VERNICE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GRESHAM DR STE 907
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1921
Mailing Address - Country:US
Mailing Address - Phone:757-668-8866
Mailing Address - Fax:757-668-8870
Practice Address - Street 1:400 GRESHAM DR STE 907
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1921
Practice Address - Country:US
Practice Address - Phone:757-668-8866
Practice Address - Fax:757-668-8870
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical