Provider Demographics
NPI:1760751069
Name:NICKI WILLIAMSON, MSW, LCSW, LLC
Entity Type:Organization
Organization Name:NICKI WILLIAMSON, MSW, LCSW, LLC
Other - Org Name:WILLIAMSON COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:812-322-4109
Mailing Address - Street 1:101 W KIRKWOOD AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-6129
Mailing Address - Country:US
Mailing Address - Phone:812-322-4109
Mailing Address - Fax:
Practice Address - Street 1:101 W KIRKWOOD AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-6129
Practice Address - Country:US
Practice Address - Phone:812-322-4109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005688A273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit