Provider Demographics
NPI:1669190419
Name:WILLIAMS, KIM (LMSW)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELLENDALE
Mailing Address - State:DE
Mailing Address - Zip Code:19941-2066
Mailing Address - Country:US
Mailing Address - Phone:302-424-5680
Mailing Address - Fax:302-424-5681
Practice Address - Street 1:700 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLENDALE
Practice Address - State:DE
Practice Address - Zip Code:19941-2066
Practice Address - Country:US
Practice Address - Phone:302-424-5680
Practice Address - Fax:302-424-5681
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW139293104100000X
DEQ3-00002521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker