Healthcare Provider Details

I. General information

NPI: 1083189062
Provider Name (Legal Business Name): YVONNE WILLIAMS, COUNSELING & PLAY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 MONTANO RD NW RM J
ALBUQUERQUE NM
87120-2427
US

IV. Provider business mailing address

4701 MONTANO RD NW RM J
ALBUQUERQUE NM
87120-2427
US

V. Phone/Fax

Practice location:
  • Phone: 505-350-8452
  • Fax:
Mailing address:
  • Phone: 505-350-8452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YVONNE E WILLIAMS
Title or Position: COUNSELOR/OWNER
Credential: MA LPCC RPT
Phone: 505-350-8452