Healthcare Provider Details

I. General information

NPI: 1285089698
Provider Name (Legal Business Name): LATHESIA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 TIERRA DEL SOL LOOP
RIO COMMUNITIES NM
87002-7112
US

IV. Provider business mailing address

110 TIERRA DEL SOL LOOP
RIO COMMUNITIES NM
87002-7112
US

V. Phone/Fax

Practice location:
  • Phone: 505-504-3034
  • Fax:
Mailing address:
  • Phone: 505-504-3034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-0447
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: