Provider Demographics
NPI:1477274413
Name:WILLIAMS, CRYSTAL MAE (LCSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MAE
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 1:2950 BRECKENRIDGE LN STE 10A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1495
Mailing Address - Country:US
Mailing Address - Phone:502-709-7603
Mailing Address - Fax:
Practice Address - Street 1:2950 BRECKENRIDGE LN STE 10A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1495
Practice Address - Country:US
Practice Address - Phone:502-509-7079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2569571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical