Provider Demographics
NPI:1013726207
Name:WILLIAMS, SAMUEL L
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9225 BAY PLAZA BLVD STE 417
Mailing Address - Street 2:PMB 1125
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4412
Mailing Address - Country:US
Mailing Address - Phone:813-365-3730
Mailing Address - Fax:
Practice Address - Street 1:9225 BAY PLAZA BLVD STE 417
Practice Address - Street 2:PMB 1125
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4412
Practice Address - Country:US
Practice Address - Phone:813-365-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral