Provider Demographics
NPI:1184214454
Name:WILLIAMS, KIRSTEN CAMILLE (LCSW)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:CAMILLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5924 CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-1842
Mailing Address - Country:US
Mailing Address - Phone:785-656-3468
Mailing Address - Fax:
Practice Address - Street 1:5924 CARPENTER ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-1842
Practice Address - Country:US
Practice Address - Phone:785-656-3468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11120-1231041C0700X
WI132241-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker