Provider Demographics
NPI:1538487293
Name:WILLIAMS, CHARLENE YVETTE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:YVETTE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:SUITE 1DO3
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-767-5265
Mailing Address - Fax:912-767-5271
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:SUITE 1DO3
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:912-767-5265
Practice Address - Fax:912-767-5271
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW004536104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMSW004536OtherMASTER SOCIAL WORKER LICENSE NO GA COMPOSITE BOARD OF PC, SW, AND MFT