Provider Demographics
NPI:1649918459
Name:WILLIAMS, MONIQUE ADRIANNA (LPC SUPERVISOR)
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:ADRIANNA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC SUPERVISOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 WAWEENOC AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-6370
Mailing Address - Country:US
Mailing Address - Phone:281-773-3751
Mailing Address - Fax:
Practice Address - Street 1:1438 WAWEENOC AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-6370
Practice Address - Country:US
Practice Address - Phone:281-773-3751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
72294101YM0800X
TX72294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty