Provider Demographics
NPI:1083073068
Name:WILLIAMS, ANTHONY (LCDC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 17TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-3603
Mailing Address - Country:US
Mailing Address - Phone:512-731-4947
Mailing Address - Fax:
Practice Address - Street 1:2709 17TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-3603
Practice Address - Country:US
Practice Address - Phone:512-731-4947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8262101YA0400X
GA901101YA0400X
FL4280 A101YA0400X
TXMT105186225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8262OtherLCDC
FL4280 AOtherCAC
GA901OtherCADC-I
TX105186OtherLMT