Provider Demographics
NPI:1508224924
Name:WILLIAMS, MARY
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:WILLIAMS
Other - Last Name:BROOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 N MONROE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2311
Mailing Address - Country:US
Mailing Address - Phone:318-240-7278
Mailing Address - Fax:318-240-7293
Practice Address - Street 1:221 N MONROE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2311
Practice Address - Country:US
Practice Address - Phone:318-240-7278
Practice Address - Fax:318-240-7293
Is Sole Proprietor?:No
Enumeration Date:2016-01-30
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor