Provider Demographics
NPI:1497998249
Name:MARTHA WILLIAMS, LCSW
Entity Type:Organization
Organization Name:MARTHA WILLIAMS, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:731-413-2422
Mailing Address - Street 1:4789 HIGHWAY 371
Mailing Address - Street 2:
Mailing Address - City:HENNING
Mailing Address - State:TN
Mailing Address - Zip Code:38041-6319
Mailing Address - Country:US
Mailing Address - Phone:731-413-2422
Mailing Address - Fax:731-738-0300
Practice Address - Street 1:8301 HIGHWAY 87 W
Practice Address - Street 2:
Practice Address - City:HENNING
Practice Address - State:TN
Practice Address - Zip Code:38041-6234
Practice Address - Country:US
Practice Address - Phone:731-413-2422
Practice Address - Fax:731-738-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000012151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3698190Medicaid
3698190Medicare PIN