Provider Demographics
NPI:1417145756
Name:WILLIAMS, CAROL ANN (LICENSED PROFESSIONA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 ROGERS ROAD
Mailing Address - Street 2:TRANSFORMATION CENTER
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018
Mailing Address - Country:US
Mailing Address - Phone:901-485-5350
Mailing Address - Fax:
Practice Address - Street 1:1088 ROGERS RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8546
Practice Address - Country:US
Practice Address - Phone:901-485-5350
Practice Address - Fax:901-485-5350
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001665101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor