Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 006183672 | LA |
NPI | 1003263708 |
---|---|
Provider Name | Shelita Williams |
First Address | Slidell, LA 70461-5449 |
Second Address | Slidell, LA 70461-5449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2016 |
Last Update Date | 23/05/2016 |