Healthcare Provider Details

I. General information

NPI: 1558528075
Provider Name (Legal Business Name): ANDREA JOY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 BELVIEW RD
LEESVILLE LA
71446-2902
US

IV. Provider business mailing address

202 TOWER ST
LEESVILLE LA
71446-3626
US

V. Phone/Fax

Practice location:
  • Phone: 337-238-6431
  • Fax: 337-238-7070
Mailing address:
  • Phone: 337-392-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: