MEDICARE: MRS. KATRINA RAJA'NAE WILLIAMS LPC-R

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0704014484	VA

General Provider Information

NPI Number	:	1770243511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATRINA RAJA'NAE WILLIAMS LPC-R

Provider Business Mailing Address
First Line	:	3657 DEERFIELD DR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-2214
Country	:	US
Telephone Number	:	757-371-6116
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 GRANBY ST STE 105
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2531
Country	:	US
Telephone Number	:	757-447-7382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2021
Last Update Date	:	12/21/2021

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