Healthcare Provider Details

I. General information

NPI: 1518400332
Provider Name (Legal Business Name): MELVINA LA FAYE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 HIGHWAY 2
STERLINGTON LA
71280
US

IV. Provider business mailing address

113 WARDEN ST PO BOX 516
DELHI LA
71232-2442
US

V. Phone/Fax

Practice location:
  • Phone: 318-598-5040
  • Fax: 844-270-1958
Mailing address:
  • Phone: 318-680-5173
  • Fax: 318-878-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: