Healthcare Provider Details

I. General information

NPI: 1164445805
Provider Name (Legal Business Name): JANICE M. WILLIAMS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W HILL BLVD
CHARLESTON AFB SC
29404-4704
US

IV. Provider business mailing address

204 W HILL BLVD
CHARLESTON AFB SC
29404-4704
US

V. Phone/Fax

Practice location:
  • Phone: 843-577-5011
  • Fax: 843-805-5957
Mailing address:
  • Phone: 843-963-6852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002106
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: