Provider Demographics
NPI:1205041803
Name:WILLIAMS, AUDREY RENAE (LPC)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:RENAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 THORNTREE DR
Mailing Address - Street 2:
Mailing Address - City:OVILLA
Mailing Address - State:TX
Mailing Address - Zip Code:75154-1635
Mailing Address - Country:US
Mailing Address - Phone:972-217-1885
Mailing Address - Fax:866-593-6754
Practice Address - Street 1:1910 PACIFIC AVE STE 8080
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4529
Practice Address - Country:US
Practice Address - Phone:214-612-5434
Practice Address - Fax:866-593-6754
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60535101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional