Healthcare Provider Details

I. General information

NPI: 1750698890
Provider Name (Legal Business Name): ANDREA WILLIAMS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S TRENTON ST
RUSTON LA
71270-5040
US

IV. Provider business mailing address

1003 PECAN ST
RUSTON LA
71270-5809
US

V. Phone/Fax

Practice location:
  • Phone: 318-251-2322
  • Fax: 318-251-0710
Mailing address:
  • Phone: 318-251-1563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2794
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2794
Identifier TypeOTHER
Identifier StateLA
Identifier IssuerLICENSED PROFESSIONA COUNSELORS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: