MEDICARE: WILLIAM MARK WILLIAMS LCSW

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	SW8643	FL

General Provider Information

NPI Number	:	1083917181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM MARK WILLIAMS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 2958
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32513-2958
Country	:	US
Telephone Number	:	850-261-8446
Fax Number	:	850-465-3706

Provider Business Practice Location Address
First Line	:	7100 PLANTATION RD STE 10
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-6234
Country	:	US
Telephone Number	:	850-261-8446
Fax Number	:	850-465-3706

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2010
Last Update Date	:	04/14/2017

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