Provider Demographics
NPI:1801082771
Name:WILLIAMS, HEATHER DENISE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DENISE
Other - Last Name:MANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 N CONGRESS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39201-1902
Mailing Address - Country:US
Mailing Address - Phone:601-326-3760
Mailing Address - Fax:601-960-8493
Practice Address - Street 1:200 N CONGRESS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201-1902
Practice Address - Country:US
Practice Address - Phone:601-326-3760
Practice Address - Fax:601-960-8493
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LPC 1275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional