Healthcare Provider Details

I. General information

NPI: 1053393256
Provider Name (Legal Business Name): JOSEPH A WILLIAMS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E SUNSET DR
MAYFIELD KY
42066-3265
US

IV. Provider business mailing address

209 E SUNSET DR
MAYFIELD KY
42066-3265
US

V. Phone/Fax

Practice location:
  • Phone: 270-247-5667
  • Fax: 888-706-9549
Mailing address:
  • Phone: 270-247-5667
  • Fax: 888-706-9549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1898
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: