Provider Demographics
NPI:1528734613
Name:WILLIAMSON, MAVIS C (MA, PLPC)
Entity type:Individual
Prefix:
First Name:MAVIS
Middle Name:C
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 RUE DE GABRIEL
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-8243
Mailing Address - Country:US
Mailing Address - Phone:318-214-4002
Mailing Address - Fax:
Practice Address - Street 1:830 4TH ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-4569
Practice Address - Country:US
Practice Address - Phone:318-214-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator