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General NPI Number Information
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NPI Number | 1225308174
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Entity Type | Individual
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Provider Name | BERTHA DAVIS-WILLIAMS PH.D., LPC
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Gender | Female
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 156 AIRLINE AVENUE
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City | GRAMERCY
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State | LA
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Zip | 70052-0933
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Country | US
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Telephone | 225-623-9751
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Fax | 225-869-8758
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Provider Business Mailing Address
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Address Line | PO BOX 933
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City | GRAMERCY
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State | LA
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Zip | 70052-0933
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Country | US
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Telephone | 225-623-9751
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Fax | 225-869-8758
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3629
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License Number State | LA
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