Healthcare Provider Details

I. General information

NPI: 1114232303
Provider Name (Legal Business Name): CHRISTY WILLIAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15921 BOUNDARY DR
ASHLAND MS
38603-7740
US

IV. Provider business mailing address

PO BOX 515
RIPLEY MS
38663-0515
US

V. Phone/Fax

Practice location:
  • Phone: 662-224-8951
  • Fax: 662-224-6459
Mailing address:
  • Phone: 662-837-0000
  • Fax: 662-837-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM7536
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: