Provider Demographics
NPI:1427425917
Name:WILLIAMS, LAFARRO (C060512844)
Entity type:Individual
Prefix:
First Name:LAFARRO
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:C060512844
Other - Prefix:MR
Other - First Name:LAFARRO
Other - Middle Name:DESHAWN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:614 PETERSON RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-2606
Mailing Address - Country:US
Mailing Address - Phone:360-757-0131
Mailing Address - Fax:360-757-0136
Practice Address - Street 1:614 PETERSON RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-2606
Practice Address - Country:US
Practice Address - Phone:360-757-0131
Practice Address - Fax:360-757-0136
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW615069711041C0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)