MEDICARE: TAVARIS WILLIAMS LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6447C	AL

General Provider Information

NPI Number	:	1104785575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAVARIS WILLIAMS LICSW

Provider Business Mailing Address
First Line	:	4517 SAGEWOOD LN
Second Line	:
City	:	CENTER POINT
State	:	AL
Zip	:	35215-5856
Country	:	US
Telephone Number	:	334-557-9941
Fax Number	:

Provider Business Practice Location Address
First Line	:	4517 SAGEWOOD LN
Second Line	:
City	:	CENTER POINT
State	:	AL
Zip	:	35215-5856
Country	:	US
Telephone Number	:	334-557-9941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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