Provider Demographics
NPI:1043307036
Name:WILLIAMS, GEORGE EDWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:EDWARD
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 1:231 E FERN DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7503
Mailing Address - Country:US
Mailing Address - Phone:386-774-4498
Mailing Address - Fax:386-774-4498
Practice Address - Street 1:231 E FERN DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7503
Practice Address - Country:US
Practice Address - Phone:386-774-4498
Practice Address - Fax:386-774-4498
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 40251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6640Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION
FLK3789Medicare ID - Type UnspecifiedELECTRONIC SENDER NUMBER