Provider Demographics
NPI:1093439432
Name:WILLLIAMS, CHANCIA T (PLPC)
Entity Type:Individual
Prefix:
First Name:CHANCIA
Middle Name:T
Last Name:WILLLIAMS
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 S BRENTWOOD BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1315
Mailing Address - Country:US
Mailing Address - Phone:314-365-6285
Mailing Address - Fax:816-508-1618
Practice Address - Street 1:1750 S BRENTWOOD BLVD STE 205
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-1315
Practice Address - Country:US
Practice Address - Phone:314-365-6285
Practice Address - Fax:816-508-1618
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022018111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health