Provider Demographics
NPI:1760012918
Name:WILLIAMS, KATELYN J (ALC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 WESTGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-3073
Mailing Address - Country:US
Mailing Address - Phone:334-721-2792
Mailing Address - Fax:334-699-3734
Practice Address - Street 1:540 WESTGATE PKWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-3073
Practice Address - Country:US
Practice Address - Phone:334-721-2792
Practice Address - Fax:334-699-3734
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3451A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional