Provider Demographics
NPI:1174807671
Name:WILLIAMS, THERESA JESSICA (LPC)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:JESSICA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5761 ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-0400
Mailing Address - Country:US
Mailing Address - Phone:337-540-7465
Mailing Address - Fax:
Practice Address - Street 1:2115 FITZENRIETER RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-1139
Practice Address - Country:US
Practice Address - Phone:337-217-4890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3408101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional