Provider Demographics
NPI:1083910129
Name:ROBIN A. WILLIAMS, PH.D.,LLC
Entity Type:Organization
Organization Name:ROBIN A. WILLIAMS, PH.D.,LLC
Other - Org Name:RESTORATION BY DESIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW, CSAC
Authorized Official - Phone:715-235-5557
Mailing Address - Street 1:1421 BROADWAY ST N
Mailing Address - Street 2:SUITE 112B
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-4728
Mailing Address - Country:US
Mailing Address - Phone:715-235-5557
Mailing Address - Fax:715-235-5559
Practice Address - Street 1:1421 BROADWAY ST N
Practice Address - Street 2:SUITE 112B
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-4728
Practice Address - Country:US
Practice Address - Phone:715-235-5557
Practice Address - Fax:715-235-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI104100000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI8JWS5CSVPMedicaid