Provider Demographics
NPI:1275540684
Name:WILLIAMS, COLLEEN MARIE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6725
Mailing Address - Country:US
Mailing Address - Phone:575-491-3419
Mailing Address - Fax:575-415-3323
Practice Address - Street 1:1213 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6725
Practice Address - Country:US
Practice Address - Phone:575-491-3419
Practice Address - Fax:575-415-3323
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0106911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27406229Medicaid