Healthcare Provider Details

I. General information

NPI: 1952001836
Provider Name (Legal Business Name): CARNESHA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25793 HIGHWAY 61
ANGUILLA MS
38721-9565
US

IV. Provider business mailing address

132 BEALE ST
HOLLANDALE MS
38748-9651
US

V. Phone/Fax

Practice location:
  • Phone: 662-390-3195
  • Fax:
Mailing address:
  • Phone: 662-390-3195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: