=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750808705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARRELL WILLIAMS MSW, LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2017
-----------------------------------------------------
Last Update Date | 05/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2285 BENTON RD STE D103
-----------------------------------------------------
City | BOSSIER CITY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71111-3465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-584-7197
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7046
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71137-7046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-440-6799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 14490
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 14490
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------