Provider Demographics
NPI:1548768914
Name:WILLIAMS, ELIZABETH (LAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13324 W OCOTILLO LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-5255
Mailing Address - Country:US
Mailing Address - Phone:517-755-7322
Mailing Address - Fax:
Practice Address - Street 1:17505 N 79TH AVE
Practice Address - Street 2:311-G
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8725
Practice Address - Country:US
Practice Address - Phone:623-876-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-16026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health