Provider Demographics
NPI:1073984266
Name:WILLIAMS, MELENE (MANAGER)
Entity Type:Individual
Prefix:MRS
First Name:MELENE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MANAGER
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:WISE
Other - Last Name:GASTINELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR KIM W GASTINELL
Mailing Address - Street 1:6400 GENERAL MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-2020
Mailing Address - Country:US
Mailing Address - Phone:504-975-1750
Mailing Address - Fax:866-653-7509
Practice Address - Street 1:6400 GENERAL MEYER AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-2020
Practice Address - Country:US
Practice Address - Phone:504-975-1750
Practice Address - Fax:866-653-7509
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA47-5122250101YM0800X
LA3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA47-5122250Medicaid
LA47-5122250OtherMEDICARE