Provider Demographics
NPI:1427566306
Name:WILLIAMS, CAROLYN FAYE
Entity Type:Individual
Prefix:MISS
First Name:CAROLYN
Middle Name:FAYE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SHILOH DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-7712
Mailing Address - Country:US
Mailing Address - Phone:850-313-9548
Mailing Address - Fax:
Practice Address - Street 1:330 SHILOH DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-7712
Practice Address - Country:US
Practice Address - Phone:850-313-9548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-13
Last Update Date:2018-02-09
Deactivation Date:2018-01-18
Deactivation Code:
Reactivation Date:2018-02-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No252Y00000XAgenciesEarly Intervention Provider Agency