Healthcare Provider Details

I. General information

NPI: 1134594666
Provider Name (Legal Business Name): ANGELIQUE T WILLIAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 MELVILLE DEWEY DR STE 209
METAIRIE LA
70002-3445
US

IV. Provider business mailing address

3515 MELVILLE DEWEY DR STE 209
METAIRIE LA
70002-3445
US

V. Phone/Fax

Practice location:
  • Phone: 504-276-4862
  • Fax:
Mailing address:
  • Phone: 504-276-4862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10479
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: