Provider Demographics
NPI:1225288541
Name:WILLIAMS, STEPHANNIE RAYE (CM)
Entity Type:Individual
Prefix:
First Name:STEPHANNIE
Middle Name:RAYE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 SUMMAR DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3906
Mailing Address - Country:US
Mailing Address - Phone:731-541-8344
Mailing Address - Fax:731-935-8327
Practice Address - Street 1:2035 SAINT JOHN AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2209
Practice Address - Country:US
Practice Address - Phone:731-541-8344
Practice Address - Fax:731-935-8327
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical