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NPI Code Detail

MEDICARE: ANNETTA WILLIAMS LCSW

MEDICARE: ANNETTA 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
11041C0700XClinical Social Worker0904008531VA

General Provider Information

NPI Number : 1952729865
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNETTA WILLIAMS LCSW
Provider Business Mailing Address
First Line : 25 S UNION ST
Second Line :
City : PETERSBURG
State : VA
Zip : 23803-4221
Country : US
Telephone Number : 804-379-0400
Fax Number :
Provider Business Practice Location Address
First Line : 25 S UNION ST
Second Line :
City : PETERSBURG
State : VA
Zip : 23803-4221
Country : US
Telephone Number : 804-957-9601
Fax Number : 804-957-5850
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2014
Last Update Date : 10/08/2019

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