Provider Demographics
NPI:1801839204
Name:WILLIAMS, MARK ALLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3190
Mailing Address - Country:US
Mailing Address - Phone:843-425-7142
Mailing Address - Fax:866-807-5863
Practice Address - Street 1:886 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3190
Practice Address - Country:US
Practice Address - Phone:843-425-7142
Practice Address - Fax:866-807-5863
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC994103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical