Provider Demographics
NPI:1043983224
Name:WILLIAMS, KAWANA NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:KAWANA
Middle Name:NICOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7632 S SOUTH SHORE DR APT 2C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-4426
Mailing Address - Country:US
Mailing Address - Phone:773-512-6083
Mailing Address - Fax:
Practice Address - Street 1:5255 N HOYNE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1227
Practice Address - Country:US
Practice Address - Phone:309-269-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
COLPP.0001632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional