Provider Demographics
NPI:1124582119
Name:WILLIAMS, RETTA ARLENE
Entity Type:Individual
Prefix:MS
First Name:RETTA
Middle Name:ARLENE
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 1:13221 SAGE MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5183
Mailing Address - Country:US
Mailing Address - Phone:281-965-2949
Mailing Address - Fax:
Practice Address - Street 1:15311 VANTAGE PKWY W STE 309
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-1962
Practice Address - Country:US
Practice Address - Phone:281-965-2949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health