Provider Demographics
NPI:1558579102
Name:WILLIAMS, PATRICIA ANN (CDMS, CCM)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CDMS, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 BRAMBLEWOOD CT
Mailing Address - Street 2:P. O. BOX 602
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-9268
Mailing Address - Country:US
Mailing Address - Phone:740-574-4288
Mailing Address - Fax:740-574-9833
Practice Address - Street 1:2733 BRAMBLEWOOD CT
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-9268
Practice Address - Country:US
Practice Address - Phone:740-574-4288
Practice Address - Fax:740-574-9833
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCCM ID 00020095171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator