Provider Demographics
NPI:1114379344
Name:WILLIAMS, SHAMARRA
Entity Type:Individual
Prefix:
First Name:SHAMARRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6141 MASTERS DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-4117
Mailing Address - Country:US
Mailing Address - Phone:318-294-4336
Mailing Address - Fax:
Practice Address - Street 1:1950 EARL ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-2908
Practice Address - Country:US
Practice Address - Phone:318-294-4336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2023-04-24
Deactivation Date:2023-03-22
Deactivation Code:
Reactivation Date:2023-03-28
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
LA171M00000X
LAPLC9534101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator