MEDICARE: MICHAEL RYAN WILLIAMS LCSW

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	0904003054	VA
2	1041C0700X	Clinical Social Worker	001100	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	175719	OTHER	VA	BCBS

General Provider Information

NPI Number	:	1144223884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL RYAN WILLIAMS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 246
Second Line	:
City	:	NORTON
State	:	VA
Zip	:	24273-0246
Country	:	US
Telephone Number	:	276-679-0162
Fax Number	:	276-679-0164

Provider Business Practice Location Address
First Line	:	18 SEVENTH ST
Second Line	:	PARK AVE CENTER, SUITE 207
City	:	NORTON
State	:	VA
Zip	:	24273
Country	:	US
Telephone Number	:	276-679-0162
Fax Number	:	276-679-0164

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

Provider Enumeration Date	:	05/25/2005
Last Update Date	:	07/08/2007

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