Provider Demographics
NPI:1508182718
Name:WILLIAMS, MARC (LAC)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LAC
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 1222
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-1222
Mailing Address - Country:US
Mailing Address - Phone:802-366-1001
Mailing Address - Fax:
Practice Address - Street 1:2434 DEPOT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9418
Practice Address - Country:US
Practice Address - Phone:802-366-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091-0000149171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist