Provider Demographics
NPI:1407306343
Name:WILLIAMS, CHUNDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:CHUNDRA
Middle Name:
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 1:1868 MCKELVEY HILL DR
Mailing Address - Street 2:APT D
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3926
Mailing Address - Country:US
Mailing Address - Phone:314-873-9723
Mailing Address - Fax:
Practice Address - Street 1:1868 MCKELVEY HILL DR
Practice Address - Street 2:APT D
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3926
Practice Address - Country:US
Practice Address - Phone:314-873-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160165691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical