Provider Demographics
NPI:1972188738
Name:WILLIAMS, KINETA L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KINETA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5329 BLACKSTONE LN
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-1143
Mailing Address - Country:US
Mailing Address - Phone:985-705-2991
Mailing Address - Fax:
Practice Address - Street 1:5329 BLACKSTONE LN
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-1143
Practice Address - Country:US
Practice Address - Phone:985-705-2991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3832C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical