Provider Demographics
NPI:1275833725
Name:BURNETT WILLIAMS, CAROL (LPC, MS, CMHT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:BURNETT WILLIAMS
Suffix:
Gender:F
Credentials:LPC, MS, CMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 W 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7405
Mailing Address - Country:US
Mailing Address - Phone:985-520-2920
Mailing Address - Fax:866-465-0075
Practice Address - Street 1:814 W 21ST AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7405
Practice Address - Country:US
Practice Address - Phone:985-520-2920
Practice Address - Fax:866-465-0075
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5610101Y00000X, 101YP2500X
MS1698101Y00000X
MS1922106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3226456Medicaid