Provider Demographics
NPI:1245079680
Name:WILLIAMS, ROBERTA SUSAN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:SUSAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:IL
Mailing Address - Zip Code:62924-1223
Mailing Address - Country:US
Mailing Address - Phone:618-713-6842
Mailing Address - Fax:
Practice Address - Street 1:28 CHICK ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-2467
Practice Address - Country:US
Practice Address - Phone:618-524-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006128101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional