Provider Demographics
NPI:1083917181
Name:WILLIAMS, WILLIAM MARK (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARK
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 2958
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2958
Mailing Address - Country:US
Mailing Address - Phone:850-261-8446
Mailing Address - Fax:850-465-3706
Practice Address - Street 1:7100 PLANTATION RD STE 10
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6234
Practice Address - Country:US
Practice Address - Phone:850-261-8446
Practice Address - Fax:850-465-3706
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW8643101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$OtherSELF