Provider Demographics
NPI:1780006288
Name:WILLIAMS, SALLY
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
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 1:6000 LAMAR AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3234
Mailing Address - Country:US
Mailing Address - Phone:913-831-2550
Mailing Address - Fax:913-826-1589
Practice Address - Street 1:6000 LAMAR AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-3234
Practice Address - Country:US
Practice Address - Phone:913-831-2550
Practice Address - Fax:913-826-1589
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCAC 430101YA0400X
KSLMSW 2404104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)