Provider Demographics
NPI:1720024862
Name:WILLIAMS, SANDRA LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 HIGHWAY 25B
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-6406
Mailing Address - Country:US
Mailing Address - Phone:501-250-0000
Mailing Address - Fax:501-362-0915
Practice Address - Street 1:2237 HIGHWAY 25B
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-6406
Practice Address - Country:US
Practice Address - Phone:501-250-0000
Practice Address - Fax:501-362-0915
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR987C103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK143751744Medicaid
AK142408019Medicaid
AR5S643Medicare PIN
AK142408019Medicaid