MEDICARE: HUBERT WILLIAMS JR. LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	86000421A	IN

General Provider Information

NPI Number	:	1790378412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUBERT WILLIAMS JR. LAC

Provider Business Mailing Address
First Line	:	405 COLLEGE AVE
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-5363
Country	:	US
Telephone Number	:	267-455-9123
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 COLLEGE AVE
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-5363
Country	:	US
Telephone Number	:	267-455-9123
Fax Number	:

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

Provider Enumeration Date	:	02/12/2021
Last Update Date	:	02/12/2021

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