Provider Demographics
NPI:1982295721
Name:WILLIAMS, KANISE R (LPCA)
Entity Type:Individual
Prefix:
First Name:KANISE
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 DUVALLE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-1967
Mailing Address - Country:US
Mailing Address - Phone:502-489-1488
Mailing Address - Fax:
Practice Address - Street 1:1941 BISHOP LN STE 1019
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1928
Practice Address - Country:US
Practice Address - Phone:502-369-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY268330101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor