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NPI Code Detail

MEDICARE: CANENTRA WILLIAMS

MEDICARE: CANENTRA WILLIAMS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1720408008
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANENTRA WILLIAMS
Provider Business Mailing Address
First Line : 2108 S PULASKI RD
Second Line :
City : CHICAGO
State : IL
Zip : 60623-2826
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1448 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60622-6412
Country : US
Telephone Number : 312-476-9064
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2014
Last Update Date : 10/10/2025

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Directions to “ CANENTRA WILLIAMS ” Practice Location

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