Provider Demographics
NPI:1407323868
Name:WILLIAMS, AMANDA RACHAEL
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RACHAEL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1258 BROWNSWITCH RD STE C
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-1606
Mailing Address - Country:US
Mailing Address - Phone:985-661-0560
Mailing Address - Fax:
Practice Address - Street 1:1258 BROWNSWITCH RD STE C
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-1606
Practice Address - Country:US
Practice Address - Phone:985-661-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LAPLPC8680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator