Healthcare Provider Details

I. General information

NPI: 1437405990
Provider Name (Legal Business Name): MARTHE J WILLIAMS MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 RUTLEDGE ST
COLUMBIA SC
29204-2520
US

IV. Provider business mailing address

2625 RUTLEDGE ST
COLUMBIA SC
29204-2520
US

V. Phone/Fax

Practice location:
  • Phone: 893-799-0144
  • Fax: 803-799-1136
Mailing address:
  • Phone: 893-799-0144
  • Fax: 803-799-1136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3225
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3225
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: