Healthcare Provider Details

I. General information

NPI: 1003012485
Provider Name (Legal Business Name): STEPHANIE WILLIAMSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OFFICE PARK STE 305 273 AZALEA ROAD
MOBILE AL
36609-1970
US

IV. Provider business mailing address

151 LIBERTY ST
FAIRHOPE AL
36532-1575
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-2022
  • Fax:
Mailing address:
  • Phone: 251-929-7875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2295
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: