Provider Demographics
NPI:1164797387
Name:WILLIAMS, KATHERINE P (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:P
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 HIGHWAY 109
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1160
Mailing Address - Country:US
Mailing Address - Phone:314-371-6500
Mailing Address - Fax:
Practice Address - Street 1:2634 HIGHWAY 109
Practice Address - Street 2:SUITE E
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1160
Practice Address - Country:US
Practice Address - Phone:314-802-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110352211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical