Provider Demographics
NPI:1497270888
Name:WILLIAMS, ROSALYN (MA)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 GOSSAMER DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-8420
Mailing Address - Country:US
Mailing Address - Phone:318-670-3984
Mailing Address - Fax:
Practice Address - Street 1:800 SPRING ST STE 215
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3757
Practice Address - Country:US
Practice Address - Phone:318-227-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health