Provider Demographics
NPI:1871567693
Name:WILLIAMS, WILLIAM EUGENE (LCSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EUGENE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCSW
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 7737
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-7737
Mailing Address - Country:US
Mailing Address - Phone:478-923-3762
Mailing Address - Fax:478-923-0362
Practice Address - Street 1:1047 N HOUSTON RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-1505
Practice Address - Country:US
Practice Address - Phone:478-923-3762
Practice Address - Fax:478-923-0362
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0016941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055000354AMedicaid
GA511I80030Medicare PIN