Provider Demographics
NPI:1073826186
Name:WILLIAMS, ROQUEL A (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:ROQUEL
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-4404
Mailing Address - Country:US
Mailing Address - Phone:318-865-2888
Mailing Address - Fax:318-865-2814
Practice Address - Street 1:566 E 71ST ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-4404
Practice Address - Country:US
Practice Address - Phone:318-865-2888
Practice Address - Fax:318-865-2814
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-17
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No173F00000XOther Service ProvidersSleep Specialist, PhD
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist