Provider Demographics
NPI:1457955684
Name:WILLIAMS, FAHAMISHA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:FAHAMISHA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 BROOK FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-8845
Mailing Address - Country:US
Mailing Address - Phone:224-419-4924
Mailing Address - Fax:
Practice Address - Street 1:2447 BRUNSWICK CIR APT C
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2057
Practice Address - Country:US
Practice Address - Phone:602-403-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1274411041C0700X
AZLCSW-220881041C0700X
IL149.0226841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical