Provider Demographics
NPI:1346932506
Name:WILLIAMS, MACY ELISE
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:ELISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 OHKAHTEEAH RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:SC
Mailing Address - Zip Code:29630-9563
Mailing Address - Country:US
Mailing Address - Phone:864-868-6346
Mailing Address - Fax:
Practice Address - Street 1:1146 OLD CENTRAL RD APT 603
Practice Address - Street 2:
Practice Address - City:CENTRAL
Practice Address - State:SC
Practice Address - Zip Code:29630-4006
Practice Address - Country:US
Practice Address - Phone:864-868-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician