Healthcare Provider Details

I. General information

NPI: 1649782061
Provider Name (Legal Business Name): KHALILAH A WILLIAMS LAMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 COOLIDGE ST
PLAINFIELD NJ
07062-2100
US

IV. Provider business mailing address

826 COOLIDGE ST
PLAINFIELD NJ
07062-2100
US

V. Phone/Fax

Practice location:
  • Phone: 732-997-0443
  • Fax:
Mailing address:
  • Phone: 732-997-0443
  • Fax:

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 Code101Y00000X
TaxonomyCounselor
License Number
License Number State

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: