Provider Demographics
NPI:1851389910
Name:WILLIAMS, MARK L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCSW
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Mailing Address - Street 1:8202 CLEARVISTA PKWY
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1400
Mailing Address - Country:US
Mailing Address - Phone:317-288-9942
Mailing Address - Fax:317-288-9945
Practice Address - Street 1:8202 CLEARVISTA PKWY
Practice Address - Street 2:SUITE 6A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1400
Practice Address - Country:US
Practice Address - Phone:317-288-9942
Practice Address - Fax:317-288-9945
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN34002500A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400027237Medicare PIN