Healthcare Provider Details

I. General information

NPI: 1801839204
Provider Name (Legal Business Name): MARK ALLEN WILLIAMS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

886 JOHNNIE DODDS BLVD SUITE 102
MOUNT PLEASANT SC
29464-3190
US

IV. Provider business mailing address

886 JOHNNIE DODDS BLVD SUITE 102
MOUNT PLEASANT SC
29464-3190
US

V. Phone/Fax

Practice location:
  • Phone: 843-425-7142
  • Fax: 866-807-5863
Mailing address:
  • Phone: 843-425-7142
  • Fax: 866-807-5863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number994
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number994
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: