Provider Demographics
NPI:1649980962
Name:WILLIAMS, SAMUEL JR (LPC-A)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 EVEREST CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2227
Mailing Address - Country:US
Mailing Address - Phone:817-948-5547
Mailing Address - Fax:
Practice Address - Street 1:5431 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-4836
Practice Address - Country:US
Practice Address - Phone:817-948-5547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health