Healthcare Provider Details

I. General information

NPI: 1497694475
Provider Name (Legal Business Name): LAZETTA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 INDIAN RIVER RD STE 35
CHESAPEAKE VA
23325-3100
US

IV. Provider business mailing address

4310 INDIAN RIVER RD
CHESAPEAKE VA
23325-3100
US

V. Phone/Fax

Practice location:
  • Phone: 757-389-0841
  • Fax:
Mailing address:
  • Phone: 757-389-0841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: