Provider Demographics
NPI:1699196188
Name:WILLIAMS, BOBBY (LCSW)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 REA ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-2142
Mailing Address - Country:US
Mailing Address - Phone:318-357-3122
Mailing Address - Fax:318-357-3240
Practice Address - Street 1:210 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6052
Practice Address - Country:US
Practice Address - Phone:318-357-3122
Practice Address - Fax:318-357-3240
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA94551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA9455OtherLICENSE # LCSW