Provider Demographics
NPI:1164845830
Name:WILLIAMSON, HEATHER (LISW-CP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 LEYLAND DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8496
Mailing Address - Country:US
Mailing Address - Phone:843-409-3234
Mailing Address - Fax:
Practice Address - Street 1:1505 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4131
Practice Address - Country:US
Practice Address - Phone:843-409-3234
Practice Address - Fax:843-580-8301
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2017-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1341Medicaid