Provider Demographics
NPI:1760376255
Name:WILLIAMS, LADARRIUS TREMELL
Entity type:Individual
Prefix:
First Name:LADARRIUS
Middle Name:TREMELL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 ARBOR LAKE DR N
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-2816
Mailing Address - Country:US
Mailing Address - Phone:901-834-3223
Mailing Address - Fax:
Practice Address - Street 1:1352 ARBOR LAKE DR N
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-2816
Practice Address - Country:US
Practice Address - Phone:901-834-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7468101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health