Provider Demographics
NPI:1790378412
Name:WILLIAMS, HUBERT JR (LAC)
Entity Type:Individual
Prefix:
First Name:HUBERT
Middle Name:
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5363
Mailing Address - Country:US
Mailing Address - Phone:267-455-9123
Mailing Address - Fax:
Practice Address - Street 1:405 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5363
Practice Address - Country:US
Practice Address - Phone:267-455-9123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000421A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)