Provider Demographics
NPI:1861492290
Name:WILLIAMS, ROBERT T (MSW,LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:T
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 WILMA RUDOLPH BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-7079
Mailing Address - Country:US
Mailing Address - Phone:931-998-0480
Mailing Address - Fax:
Practice Address - Street 1:1725 WILMA RUDOLPH BLVD STE I
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-7079
Practice Address - Country:US
Practice Address - Phone:931-998-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8200105800Medicaid
S99416Medicare UPIN
KY0687710Medicare ID - Type Unspecified