Provider Demographics
NPI:1629178876
Name:WILLIAMS, KELLEY LYNNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:LYNNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:LYNNE
Other - Last Name:JEFFRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 OPAL LN
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BEND
Mailing Address - State:AR
Mailing Address - Zip Code:72512
Mailing Address - Country:US
Mailing Address - Phone:870-670-4678
Mailing Address - Fax:
Practice Address - Street 1:2200 FT ROOTS DR
Practice Address - Street 2:CAVHS
Practice Address - City:NO LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114
Practice Address - Country:US
Practice Address - Phone:501-257-3313
Practice Address - Fax:501-257-3329
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1531C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical