Provider Demographics
NPI:1578303772
Name:WILLIAMS, KATHLEEN N (LSAA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:N
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 CALIFORNIA ST SE TRLR 14
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-5304
Mailing Address - Country:US
Mailing Address - Phone:505-582-4114
Mailing Address - Fax:
Practice Address - Street 1:12021 SKYLINE RD NE APT 2003
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2884
Practice Address - Country:US
Practice Address - Phone:505-582-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0249101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)