Provider Demographics
NPI:1871861708
Name:WILLIAMS, SYDNEY (LSAA)
Entity Type:Individual
Prefix:MRS
First Name:SYDNEY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6677 AUGUSTA HILLS DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-8642
Mailing Address - Country:US
Mailing Address - Phone:505-404-9800
Mailing Address - Fax:
Practice Address - Street 1:6677 AUGUSTA HILLS DR NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-8642
Practice Address - Country:US
Practice Address - Phone:505-404-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0144301101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)