Provider Demographics
NPI:1689145740
Name:WILLIAMS, CAREY B
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:B
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 BLUE JAY DR APT 3
Mailing Address - Street 2:
Mailing Address - City:LYNDON
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3978
Mailing Address - Country:US
Mailing Address - Phone:502-548-3877
Mailing Address - Fax:
Practice Address - Street 1:1606 BLUE JAY DR APT 3
Practice Address - Street 2:
Practice Address - City:LYNDON
Practice Address - State:KY
Practice Address - Zip Code:40222-3978
Practice Address - Country:US
Practice Address - Phone:502-548-3877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
KY246509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator