Provider Demographics
NPI:1255431003
Name:WILLIAMS, THOMAS EUGENE (MSW LICSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EUGENE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 CHRISTY DR
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MN
Mailing Address - Zip Code:55315-4592
Mailing Address - Country:US
Mailing Address - Phone:592-705-6895
Mailing Address - Fax:
Practice Address - Street 1:7400 METRO BLVD STE 211
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2321
Practice Address - Country:US
Practice Address - Phone:952-835-1616
Practice Address - Fax:833-895-1211
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN153981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical