Provider Demographics
NPI:1346866928
Name:WILLIAMS, PHILLENIEA (MAR)
Entity Type:Individual
Prefix:MRS
First Name:PHILLENIEA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 E END BLVD N STE C
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-2128
Mailing Address - Country:US
Mailing Address - Phone:903-471-5132
Mailing Address - Fax:
Practice Address - Street 1:1006 E END BLVD N STE C
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-2128
Practice Address - Country:US
Practice Address - Phone:903-471-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health