Provider Demographics
NPI:1093585994
Name:WILLIAMS, LAQUITA SHAUNAE (LPC, CSOTP, SAC-S)
Entity type:Individual
Prefix:
First Name:LAQUITA
Middle Name:SHAUNAE
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:LPC, CSOTP, SAC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0173
Mailing Address - Country:US
Mailing Address - Phone:434-603-7829
Mailing Address - Fax:434-392-6385
Practice Address - Street 1:2720 LAYNE STREET EXT
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-3069
Practice Address - Country:US
Practice Address - Phone:434-603-7829
Practice Address - Fax:434-392-6385
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health