Healthcare Provider Details

I. General information

NPI: 1407323868
Provider Name (Legal Business Name): MRS. AMANDA RACHAEL WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 BROWNSWITCH RD STE C
SLIDELL LA
70461-1606
US

IV. Provider business mailing address

1258 BROWNSWITCH RD STE C
SLIDELL LA
70461-1606
US

V. Phone/Fax

Practice location:
  • Phone: 985-661-0560
  • Fax:
Mailing address:
  • Phone: 985-661-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3151
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8580
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: