Provider Demographics
NPI:1336704915
Name:WILLIAMS, JACQUET L (MED, NCC, NCSC)
Entity Type:Individual
Prefix:
First Name:JACQUET
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MED, NCC, NCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 CAROL SUE AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5158
Mailing Address - Country:US
Mailing Address - Phone:504-609-9113
Mailing Address - Fax:
Practice Address - Street 1:1615 CAROL SUE AVE APT 9
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-5158
Practice Address - Country:US
Practice Address - Phone:504-609-9113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional