Healthcare Provider Details

I. General information

NPI: 1497270888
Provider Name (Legal Business Name): ROSALYN WILLIAMS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 MILLER ST
MINDEN LA
71055-3344
US

IV. Provider business mailing address

6302 GOSSAMER DR
SHREVEPORT LA
71119-8420
US

V. Phone/Fax

Practice location:
  • Phone: 318-422-9028
  • Fax:
Mailing address:
  • Phone: 318-422-9028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7212
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: