Provider Demographics
NPI:1144461120
Name:WILLIAMS, KERRY LYNN (LAC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15968
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72231-5968
Mailing Address - Country:US
Mailing Address - Phone:501-221-1843
Mailing Address - Fax:501-221-2376
Practice Address - Street 1:3601 RICHARDS ROAD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117
Practice Address - Country:US
Practice Address - Phone:501-221-1843
Practice Address - Fax:501-221-2376
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0911121101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor