=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164845830
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER WILLIAMSON LISW-CP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2014
-----------------------------------------------------
Last Update Date | 12/31/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1505 W PALMETTO ST
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29501-4131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-409-3234
-----------------------------------------------------
Fax | 843-580-8301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 969 LEYLAND DR
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29501-8496
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-409-3234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 10623
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------