Provider Demographics
NPI:1497211387
Name:WILLIAMS, LATASHA MONIQUE (LCSW)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:MONIQUE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PATRIOT PLACE (VA)
Mailing Address - Street 2:314 WILLIAMS AVENUE, STE. 100
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115
Mailing Address - Country:US
Mailing Address - Phone:615-521-2560
Mailing Address - Fax:615-942-8570
Practice Address - Street 1:PATRIOT PLACE (VA)
Practice Address - Street 2:314 WILLIAMS AVENUE, STE. 100
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115
Practice Address - Country:US
Practice Address - Phone:615-521-2560
Practice Address - Fax:615-942-8570
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-42261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical