Provider Demographics
NPI:1346002102
Name:WILLIAMS, CECIL JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CECIL
Middle Name:
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 HOLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BANNER
Mailing Address - State:KY
Mailing Address - Zip Code:41603-8962
Mailing Address - Country:US
Mailing Address - Phone:606-218-5717
Mailing Address - Fax:
Practice Address - Street 1:122 HOLBROOK DR
Practice Address - Street 2:
Practice Address - City:BANNER
Practice Address - State:KY
Practice Address - Zip Code:41603-8962
Practice Address - Country:US
Practice Address - Phone:606-218-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2586821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical