Provider Demographics
NPI:1235545302
Name:WILLIAMS, ORLINDA (LADAC)
Entity Type:Individual
Prefix:
First Name:ORLINDA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4391
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-4391
Mailing Address - Country:US
Mailing Address - Phone:928-514-4715
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SUPAI
Practice Address - State:AZ
Practice Address - Zip Code:86435-0129
Practice Address - Country:US
Practice Address - Phone:928-448-2641
Practice Address - Fax:928-448-2312
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4004101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)