Basic Information
| Provider Information | |||||||||
| NPI: | 1154084747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | MARIAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14635 S HARRELLS FERRY RD STE 3A | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708162960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256128656 | ||||||||
| FaxNumber: | 2253414772 | ||||||||
| Practice Location | |||||||||
| Address1: | 11861 COURSEY BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708164404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253283218 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2021 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.