Provider Demographics
NPI:1760838429
Name:WILLIAMS, CORNIKA VASHINE
Entity Type:Individual
Prefix:
First Name:CORNIKA
Middle Name:VASHINE
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 1:3308 TULANE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-7100
Mailing Address - Country:US
Mailing Address - Phone:504-821-6830
Mailing Address - Fax:504-821-6837
Practice Address - Street 1:3308 TULANE AVE STE 407
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7158
Practice Address - Country:US
Practice Address - Phone:504-821-6830
Practice Address - Fax:504-821-6837
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010441112104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker