Healthcare Provider Details

I. General information

NPI: 1801082771
Provider Name (Legal Business Name): HEATHER DENISE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER DENISE MANLEY

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N CONGRESS ST SUITE 100
JACKSON MS
39201-1902
US

IV. Provider business mailing address

200 N CONGRESS ST SUITE 100
JACKSON MS
39201-1902
US

V. Phone/Fax

Practice location:
  • Phone: 601-326-3760
  • Fax: 601-960-8493
Mailing address:
  • Phone: 601-326-3760
  • Fax: 601-960-8493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 1275
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: