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NPI Code Detail

MEDICARE: AUTUMN WILLIAMSON MSW, LGSW

MEDICARE: AUTUMN WILLIAMSON MSW, LGSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerDP00946022WV
21041C0700XClinical Social Worker18014SC

General Provider Information

NPI Number : 1053052670
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUTUMN WILLIAMSON MSW, LGSW
Provider Business Mailing Address
First Line : 2406 KANAWHA BLVD E
Second Line :
City : CHARLESTON
State : WV
Zip : 25311-2323
Country : US
Telephone Number : 304-539-0342
Fax Number :
Provider Business Practice Location Address
First Line : 2406 KANAWHA BLVD E
Second Line :
City : CHARLESTON
State : WV
Zip : 25311-2323
Country : US
Telephone Number : 304-539-0342
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2022
Last Update Date : 03/24/2026

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