Provider Demographics
NPI:1437858867
Name:WILLIAMS, CHARKELIA STATE (MPA/PSS)
Entity Type:Individual
Prefix:
First Name:CHARKELIA
Middle Name:STATE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MPA/PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:FARMERVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71241-8108
Mailing Address - Country:US
Mailing Address - Phone:318-614-2067
Mailing Address - Fax:
Practice Address - Street 1:1808 GLENMAR AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4932
Practice Address - Country:US
Practice Address - Phone:318-614-2067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst