Provider Demographics
NPI:1225418940
Name:WILLIAMS, MALLORY BRELAND (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MALLORY
Middle Name:BRELAND
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:MALLORY
Other - Middle Name:L
Other - Last Name:BRELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:9390 RUE DE BENOIT
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-1508
Mailing Address - Country:US
Mailing Address - Phone:225-241-0824
Mailing Address - Fax:
Practice Address - Street 1:8772 QUARTERS LAKE RD # 13-8
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-7305
Practice Address - Country:US
Practice Address - Phone:225-694-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA100991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical