Provider Demographics
NPI:1457947533
Name:WILLIAMS, CAROLINE E
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5485 W 10890 N # NA
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9014
Mailing Address - Country:US
Mailing Address - Phone:817-456-5250
Mailing Address - Fax:
Practice Address - Street 1:5485 W 10890 N # NA
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9014
Practice Address - Country:US
Practice Address - Phone:817-456-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT569326103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool