Provider Demographics
NPI:1467235036
Name:WILLIAMS, SHANTIGRA (LMHC, CTP)
Entity Type:Individual
Prefix:
First Name:SHANTIGRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMHC, CTP
Other - Prefix:
Other - First Name:SHAE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC, CTP
Mailing Address - Street 1:124 NE 19TH CT APT 101B
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1066
Mailing Address - Country:US
Mailing Address - Phone:754-368-8638
Mailing Address - Fax:
Practice Address - Street 1:124 NE 19TH CT APT 101B
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305
Practice Address - Country:US
Practice Address - Phone:415-403-2156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22603101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health