Provider Demographics
NPI:1447726864
Name:WILLIAMS, TRACY LYNETTE (LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNETTE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5804 GROOM RD
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-4324
Mailing Address - Country:US
Mailing Address - Phone:225-301-6446
Mailing Address - Fax:
Practice Address - Street 1:1200 S ACADIAN THRUWAY STE 110D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6900
Practice Address - Country:US
Practice Address - Phone:225-301-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA129551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical