Provider Demographics
NPI:1689817751
Name:WILLIAMS, DEONNE MARIE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:DEONNE
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 BELTRAMI AVE NW STE 115
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3002
Mailing Address - Country:US
Mailing Address - Phone:218-214-9389
Mailing Address - Fax:218-517-2034
Practice Address - Street 1:522 BELTRAMI AVE NW
Practice Address - Street 2:SUITE 115
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3001
Practice Address - Country:US
Practice Address - Phone:218-214-9389
Practice Address - Fax:218-517-2034
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-19
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19439101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty