Provider Demographics
NPI:1619249521
Name:WILLIAMS, CALVIN CARMICHAEL (LPC)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:CARMICHAEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 LOUISVILLE AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6031
Mailing Address - Country:US
Mailing Address - Phone:318-512-6226
Mailing Address - Fax:318-387-4010
Practice Address - Street 1:1651 LOUISVILLE AVE
Practice Address - Street 2:STE 107
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6031
Practice Address - Country:US
Practice Address - Phone:318-512-6226
Practice Address - Fax:318-387-4010
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3654101YP2500X
MS836101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional