Provider Demographics
NPI:1558578112
Name:WILLIAMS, CRYSTAL Y (LCPC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:Y
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 S FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-2720
Mailing Address - Country:US
Mailing Address - Phone:773-436-2642
Mailing Address - Fax:773-436-2642
Practice Address - Street 1:532 W 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1122
Practice Address - Country:US
Practice Address - Phone:773-994-9937
Practice Address - Fax:773-994-9943
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004031101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional