Provider Demographics
NPI:1104242056
Name:WILLIAMS-JACKSON, KIMBERLY (MHP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:WILLIAMS-JACKSON
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18583 HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:POINTE A LA HACHE
Mailing Address - State:LA
Mailing Address - Zip Code:70082-0157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5630 CROWDER BLVD STE 208
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-2444
Practice Address - Country:US
Practice Address - Phone:504-241-6003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor