Provider Demographics
NPI:1619998416
Name:WILLIAMS, MARK CLAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CLAY
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 1:3851 ETHAN LANE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6567
Mailing Address - Country:US
Mailing Address - Phone:407-647-8437
Mailing Address - Fax:407-647-8437
Practice Address - Street 1:989 ORIENTA AVE
Practice Address - Street 2:LIFE CARE CENTER OF ALTAMONTE
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:407-831-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003957103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75999Medicare ID - Type Unspecified