Provider Demographics
NPI:1831673227
Name:WILLIAMS, SUSAN ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
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 1:2496 INTERLOCHEN CT # 2A
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-8706
Mailing Address - Country:US
Mailing Address - Phone:970-778-1755
Mailing Address - Fax:
Practice Address - Street 1:2496 INTERLOCHEN CT # 2A
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-8706
Practice Address - Country:US
Practice Address - Phone:970-778-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.00986028104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker