Provider Demographics
NPI:1174659932
Name:WILLIAMS, AMELIA MAE (DT)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:MAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 JULIAN DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9530
Mailing Address - Country:US
Mailing Address - Phone:812-944-9984
Mailing Address - Fax:812-944-9984
Practice Address - Street 1:3317 JULIAN DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9530
Practice Address - Country:US
Practice Address - Phone:812-944-9984
Practice Address - Fax:812-944-9984
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
373H00000X
IN39000659A101YM0800X
KYKY-0464101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200625290AOtherDEVELOPMENTAL THERAPIST