Provider Demographics
NPI:1437209525
Name:WILLIAMS, DEBORAH L (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 W 500 N
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-9107
Mailing Address - Country:US
Mailing Address - Phone:765-662-9971
Mailing Address - Fax:765-651-6563
Practice Address - Street 1:1091 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1526
Practice Address - Country:US
Practice Address - Phone:260-563-4407
Practice Address - Fax:260-563-6440
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003856A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ0017671OtherTRICARE PROVIDER ID
IN000000004027OtherMPLAN ID
IN000000317611OtherGENCORP PROVIDER ID
IN0007186320OtherAETNA PROVIDER ID
IN088367428001OtherGENERAL LISCENCE #
IN000000183247OtherANTHEM PROVIDER ID
ININ0017671OtherTRICARE PROVIDER ID