Provider Demographics
NPI:1215687934
Name:WILLIAMS, MARLENCIA JEAN (LICSW)
Entity type:Individual
Prefix:
First Name:MARLENCIA
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MARLENCIA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 2429
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8486
Mailing Address - Country:US
Mailing Address - Phone:360-353-9494
Mailing Address - Fax:360-353-9440
Practice Address - Street 1:15455 65TH AVE S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2534
Practice Address - Country:US
Practice Address - Phone:206-721-5170
Practice Address - Fax:360-353-9440
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61213994101Y00000X, 104100000X
WALW615990461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker