Provider Demographics
NPI:1376226944
Name:WILLIAMS, VONTESHEA L (MS, LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:VONTESHEA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, LPC ASSOCIATE
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 163781
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-3781
Mailing Address - Country:US
Mailing Address - Phone:682-651-7621
Mailing Address - Fax:817-887-3409
Practice Address - Street 1:1285 N MAIN ST STE 101-5
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1511
Practice Address - Country:US
Practice Address - Phone:682-651-7621
Practice Address - Fax:817-887-3409
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional