Provider Demographics
NPI:1043894173
Name:WILLIAMS, ANGEL NICOLE (RSW)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:NICOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WALL BLVD APT 12H
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-8612
Mailing Address - Country:US
Mailing Address - Phone:504-957-5230
Mailing Address - Fax:
Practice Address - Street 1:3300 WALL BLVD APT 12H
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-8612
Practice Address - Country:US
Practice Address - Phone:504-957-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16525104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker