Provider Demographics
NPI:1437373479
Name:WILLIAMS, LARRY M
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:M
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:3209 DENALI ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4030
Mailing Address - Country:US
Mailing Address - Phone:907-274-0243
Mailing Address - Fax:
Practice Address - Street 1:3209 DENALI ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4030
Practice Address - Country:US
Practice Address - Phone:907-274-0243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)