Healthcare Provider Details

I. General information

NPI: 1720816762
Provider Name (Legal Business Name): ROBBIE BURNETTE WILLIAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 S FARMERVILLE ST
RUSTON LA
71270-4654
US

IV. Provider business mailing address

PO BOX 13006
RUSTON LA
71273-3006
US

V. Phone/Fax

Practice location:
  • Phone: 318-548-1463
  • Fax: 318-548-9202
Mailing address:
  • Phone: 318-617-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4381
License Number StateLA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: