Provider Demographics
NPI:1649925736
Name:WILLIAMS, LAURA DIANE (LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:DIANE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-4355
Mailing Address - Country:US
Mailing Address - Phone:217-413-8151
Mailing Address - Fax:
Practice Address - Street 1:1220 UNDERWOOD CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1983
Practice Address - Country:US
Practice Address - Phone:217-233-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017732101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional