Provider Demographics
NPI:1104104504
Name:EARNESTINE LAMONICA WILLIAMS
Entity type:Organization
Organization Name:EARNESTINE LAMONICA WILLIAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPERITOR
Authorized Official - Prefix:
Authorized Official - First Name:EARNESTINE
Authorized Official - Middle Name:LAMONICA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-300-7515
Mailing Address - Street 1:520 S HOLLAND ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2096
Mailing Address - Country:US
Mailing Address - Phone:316-729-9965
Mailing Address - Fax:316-854-0950
Practice Address - Street 1:520 S HOLLAND ST
Practice Address - Street 2:SUITE 401
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2096
Practice Address - Country:US
Practice Address - Phone:316-729-9965
Practice Address - Fax:316-854-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty