Healthcare Provider Details

I. General information

NPI: 1164964656
Provider Name (Legal Business Name): AMY R WILLIAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY RENEE WILLIAMS LMSW

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MORGAN STREET SUITE 8
PARAGOULD AR
72450-2848
US

IV. Provider business mailing address

1815 PLEASANT GROVE ROAD
JONESBORO AR
72405-7870
US

V. Phone/Fax

Practice location:
  • Phone: 870-335-9483
  • Fax: 870-335-9487
Mailing address:
  • Phone: 870-933-6886
  • Fax: 870-933-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6212-M
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6212-C
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6212-M
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: