Provider Demographics
NPI:1689551368
Name:WILLIAMS, THOMAS MARK (P-LPC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MARK
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 FAIRWAY ST
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-7912
Mailing Address - Country:US
Mailing Address - Phone:662-809-7502
Mailing Address - Fax:
Practice Address - Street 1:1300 SUNSET DR STE M
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4082
Practice Address - Country:US
Practice Address - Phone:662-809-7502
Practice Address - Fax:662-498-5261
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-1365101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor