Provider Demographics
NPI:1407227127
Name:WILLIAMS, BREANNA (LPC)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:POLK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4700 N JOSEY LN APT 4511
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4674
Mailing Address - Country:US
Mailing Address - Phone:469-650-6917
Mailing Address - Fax:
Practice Address - Street 1:4700 N JOSEY LN APT 4511
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4674
Practice Address - Country:US
Practice Address - Phone:469-650-6917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor