Provider Demographics
NPI:1235962663
Name:WILLIAMS, KELVIN SR (LPC)
Entity type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:
Last Name:WILLIAMS
Suffix:SR
Gender:M
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:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-0933
Mailing Address - Country:US
Mailing Address - Phone:843-939-0480
Mailing Address - Fax:
Practice Address - Street 1:611 S HARVIN ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-6413
Practice Address - Country:US
Practice Address - Phone:843-939-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional