Provider Demographics
NPI:1780314641
Name:WILLIAMS, BRANDY JO (DOC)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:JO
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3341
Mailing Address - Country:US
Mailing Address - Phone:318-884-5343
Mailing Address - Fax:
Practice Address - Street 1:1900 N 18TH ST STE 412
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4419
Practice Address - Country:US
Practice Address - Phone:318-884-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC8808101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor