Provider Demographics
NPI:1245717701
Name:WILLIAMS, LISA LEBON
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LEBON
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 1:22916 JACOCKS RD
Mailing Address - Street 2:
Mailing Address - City:SLAUGHTER
Mailing Address - State:LA
Mailing Address - Zip Code:70777-9615
Mailing Address - Country:US
Mailing Address - Phone:225-305-8390
Mailing Address - Fax:
Practice Address - Street 1:22916 JACOCKS RD
Practice Address - Street 2:
Practice Address - City:SLAUGHTER
Practice Address - State:LA
Practice Address - Zip Code:70777-9615
Practice Address - Country:US
Practice Address - Phone:225-305-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical