Provider Demographics
NPI:1417393638
Name:WILLIAMS, MAVIS WILLETTE (MS)
Entity Type:Individual
Prefix:MS
First Name:MAVIS
Middle Name:WILLETTE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:MAVIS
Other - Middle Name:WILLIAMS
Other - Last Name:MCELRATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:11 MCGHEE CIR
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-4850
Mailing Address - Country:US
Mailing Address - Phone:256-245-0110
Mailing Address - Fax:
Practice Address - Street 1:1704 BETTYE ST
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:AL
Practice Address - Zip Code:35094-1701
Practice Address - Country:US
Practice Address - Phone:205-699-4781
Practice Address - Fax:205-699-2148
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health