Provider Demographics
NPI:1235420381
Name:WILLIAMS, MARY KRISTI (MA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KRISTI
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 HALLECK RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-2389
Mailing Address - Country:US
Mailing Address - Phone:304-282-5752
Mailing Address - Fax:
Practice Address - Street 1:231 DAVIS ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1703
Practice Address - Country:US
Practice Address - Phone:304-842-0044
Practice Address - Fax:304-842-0033
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV772103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist