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General NPI Number Information
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NPI Number | 1225540529
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Entity Type | Organization
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Legal Business Name | TONYA WILLIAMS
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Dates
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Enumeration Date | 10/27/2017
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 2210 LINE AVE STE 207
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City | SHREVEPORT
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State | LA
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Zip | 71104-2134
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Country | US
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Telephone | 318-773-7661
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Fax | 866-307-9980
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Provider Business Mailing Address
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Address Line | 2210 LINE AVE STE 207
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City | SHREVEPORT
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State | LA
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Zip | 71104-2134
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Country | US
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Telephone | 318-675-1112
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Fax | 866-307-9980
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TONYA WRIGHT WILLIAMS
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Credential | LICENSED
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Telephone | 318-773-7661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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Taxonomy #5
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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Taxonomy #6
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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