Healthcare Provider Details

I. General information

NPI: 1326637356
Provider Name (Legal Business Name): ASHLEY WILLIAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 NE 24TH AVE
POMPANO BEACH FL
33062-5205
US

IV. Provider business mailing address

4901 KINSEY DR APT 1414
TYLER TX
75703-3030
US

V. Phone/Fax

Practice location:
  • Phone: 954-815-5644
  • Fax:
Mailing address:
  • Phone: 954-815-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16216
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: