Provider Demographics
NPI:1699222174
Name:WILLIAMS, LATRENDA
Entity Type:Individual
Prefix:MS
First Name:LATRENDA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 PAUL MAILLARD ROAD
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070
Mailing Address - Country:US
Mailing Address - Phone:985-206-6853
Mailing Address - Fax:985-206-6857
Practice Address - Street 1:203 PAUL MAILLARD ROAD
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070
Practice Address - Country:US
Practice Address - Phone:985-206-6853
Practice Address - Fax:985-206-6857
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA800817604Medicaid