Provider Demographics
NPI:1407920655
Name:WILLIAMS, SANDRA ELAINE (LISW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ELAINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1956
Mailing Address - Street 2:TAOS PICULIS INDIAN HEALTH CENTER
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:505-758-4224
Mailing Address - Fax:505-751-5211
Practice Address - Street 1:1090 GOAT SPRINGS ROAD
Practice Address - Street 2:TAOS PICULIS INDIAN HEALTH CENTER
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:505-758-4224
Practice Address - Fax:505-751-5211
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI2921104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker