Healthcare Provider Details

I. General information

NPI: 1912438268
Provider Name (Legal Business Name): RONYA LATRICE WILLIAMS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RONYA LATRICE WARD

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N GORE AVE
SAINT LOUIS MO
63119-1600
US

IV. Provider business mailing address

1630 BAY MEADOWS DR
FLORISSANT MO
63033-2633
US

V. Phone/Fax

Practice location:
  • Phone: 314-919-4700
  • Fax:
Mailing address:
  • Phone: 314-422-4559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2015040073
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: