Healthcare Provider Details

I. General information

NPI: 1326658576
Provider Name (Legal Business Name): TERRINESHA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WICHERS DR STE 206
MARRERO LA
70072-3054
US

IV. Provider business mailing address

4700 WICHERS DR STE 206
MARRERO LA
70072-3054
US

V. Phone/Fax

Practice location:
  • Phone: 504-235-7847
  • Fax:
Mailing address:
  • Phone: 504-235-7847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: