Provider Demographics
NPI:1376501593
Name:WILLIAMS, MARY KATHERINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHERINE
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 1:4669 W TUMBLEWEED ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7642
Mailing Address - Country:US
Mailing Address - Phone:479-466-9121
Mailing Address - Fax:479-974-2002
Practice Address - Street 1:2233 N GREEN ACRES RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2833
Practice Address - Country:US
Practice Address - Phone:479-466-9121
Practice Address - Fax:479-974-2002
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1752C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT089.0134618TELEOtherSOCIAL WORK LICENSE
AR1752COtherSOCIAL WORK LICENSE
WA61413647OtherSOCIAL WORK LICENSE
AR5X496OtherBLUE CROSS PROVIDER #