Healthcare Provider Details

I. General information

NPI: 1053246769
Provider Name (Legal Business Name): CARISSA ROSE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARISSA ROSE NOVAK

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S 40TH ST STE 312
LINCOLN NE
68506-5247
US

IV. Provider business mailing address

5437 FRANCIS ST
LINCOLN NE
68504-3057
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-5069
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: