Provider Demographics
NPI:1750123360
Name:WILLIAMS BROWN, LAERICA
Entity type:Individual
Prefix:MRS
First Name:LAERICA
Middle Name:
Last Name:WILLIAMS BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9426 NORMANDIE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3812
Mailing Address - Country:US
Mailing Address - Phone:318-578-1566
Mailing Address - Fax:
Practice Address - Street 1:9426 NORMANDIE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3812
Practice Address - Country:US
Practice Address - Phone:318-578-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach