Healthcare Provider Details

I. General information

NPI: 1477826964
Provider Name (Legal Business Name): TIFFANY RENEE WILLIAMSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MAIN ST S
MC KEE KY
40447-7089
US

IV. Provider business mailing address

1010 MAIN ST S
MC KEE KY
40447-7089
US

V. Phone/Fax

Practice location:
  • Phone: 606-287-7104
  • Fax:
Mailing address:
  • Phone: 859-626-7700
  • Fax: 859-626-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW 6265 KY
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3902
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: