Provider Demographics
NPI:1205587508
Name:NAZARELL WILLIAMS LLC
Entity type:Organization
Organization Name:NAZARELL WILLIAMS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:NAZARELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-497-6694
Mailing Address - Street 1:2717 GRAND MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2174
Mailing Address - Country:US
Mailing Address - Phone:804-497-6694
Mailing Address - Fax:804-918-3062
Practice Address - Street 1:2717 GRAND MEADOWS CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2174
Practice Address - Country:US
Practice Address - Phone:804-497-6694
Practice Address - Fax:804-918-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA601457753Medicaid