Provider Demographics
NPI:1679138622
Name:WILLIAMS, LINDSEY RAE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:RAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:LINDSEY
Other - Middle Name:RAE
Other - Last Name:BLAKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4920 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2272
Mailing Address - Country:US
Mailing Address - Phone:815-227-9002
Mailing Address - Fax:608-256-0743
Practice Address - Street 1:4920 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2272
Practice Address - Country:US
Practice Address - Phone:608-280-2095
Practice Address - Fax:815-256-0743
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011329101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional