Provider Demographics
NPI:1851767578
Name:WILLIAMS, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
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 1:3018 OLD MINDEN RD
Mailing Address - Street 2:STE 1104
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2476
Mailing Address - Country:US
Mailing Address - Phone:318-746-1935
Mailing Address - Fax:318-746-2514
Practice Address - Street 1:2219 CLAIBORNE AVE STE 1104
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4301
Practice Address - Country:US
Practice Address - Phone:318-779-0434
Practice Address - Fax:318-779-0434
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker