Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1245699883 |
---|---|
Provider Name | Carl M Williams |
First Address | Baton Rouge, LA 70807-3042 |
Second Address | Baton Rouge, LA 70807-3042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2016 |
Last Update Date | 16/02/2016 |