Provider Demographics
NPI:1417447863
Name:WILLIAMS, ERNIE MICHAEL (CADC)
Entity Type:Individual
Prefix:
First Name:ERNIE
Middle Name:MICHAEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 HIGHWAY 3410
Mailing Address - Street 2:
Mailing Address - City:MAYKING
Mailing Address - State:KY
Mailing Address - Zip Code:41837-9066
Mailing Address - Country:US
Mailing Address - Phone:606-899-0910
Mailing Address - Fax:
Practice Address - Street 1:48 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9443
Practice Address - Country:US
Practice Address - Phone:606-487-1646
Practice Address - Fax:606-487-1746
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY118110101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1183054Medicaid