Provider Demographics
NPI:1972837771
Name:WILLIAMS-PETRY, TAMMY F (LISW)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:F
Last Name:WILLIAMS-PETRY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 E CENTERVILLE STATION RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-5500
Mailing Address - Country:US
Mailing Address - Phone:937-439-2984
Mailing Address - Fax:937-439-2984
Practice Address - Street 1:1055 E CENTERVILLE STATION RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-5500
Practice Address - Country:US
Practice Address - Phone:937-439-2984
Practice Address - Fax:937-439-2984
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.08002801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical