MEDICARE: MS. LATONIA 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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1902141054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LATONIA WILLIAMS

Provider Business Mailing Address
First Line	:	1514 JUNCTION CITY HIGHWAY
Second Line	:
City	:	ELDORADO
State	:	AR
Zip	:	71730
Country	:	US
Telephone Number	:	870-639-3936
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 JUNCTION CITY RD
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-7502
Country	:	US
Telephone Number	:	870-639-3935
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2012
Last Update Date	:	11/30/2012

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