Provider Demographics
NPI:1225540529
Name:TONYA WILLIAMS
Entity Type:Organization
Organization Name:TONYA WILLIAMS
Other - Org Name:THE KENNEDY CENTER OF LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED
Authorized Official - Phone:318-773-7661
Mailing Address - Street 1:2210 LINE AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2134
Mailing Address - Country:US
Mailing Address - Phone:318-675-1112
Mailing Address - Fax:866-307-9980
Practice Address - Street 1:2210 LINE AVE STE 207
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2134
Practice Address - Country:US
Practice Address - Phone:318-773-7661
Practice Address - Fax:866-307-9980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health