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General NPI Number Information
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NPI Number | 1649925736
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Entity Type | Individual
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Provider Name | LAURA DIANE WILLIAMS LPC
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Gender | Female
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 1220 UNDERWOOD CT
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City | DECATUR
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State | IL
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Zip | 62526-1983
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Country | US
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Telephone | 217-233-6811
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Fax |
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Provider Business Mailing Address
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Address Line | 4202 E LINCOLN AVE
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City | DECATUR
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State | IL
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Zip | 62521-4355
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Country | US
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Telephone | 217-413-8151
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.017732
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License Number State | IL
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