Provider Demographics
NPI:1508086042
Name:WILLIAMS, CARL L (PHD,)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4822 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-6835
Mailing Address - Country:US
Mailing Address - Phone:150-552-4581
Mailing Address - Fax:150-552-4581
Practice Address - Street 1:4822 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-6835
Practice Address - Country:US
Practice Address - Phone:150-552-4581
Practice Address - Fax:150-552-4581
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0101061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional