Provider Demographics
NPI:1700062478
Name:WILLIAMS, BONNIE LORENA (LCSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:LORENA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:MS
Other - First Name:LORENA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, BCD
Mailing Address - Street 1:6511 174TH ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3525
Mailing Address - Country:US
Mailing Address - Phone:708-444-2470
Mailing Address - Fax:
Practice Address - Street 1:6511 174TH ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3525
Practice Address - Country:US
Practice Address - Phone:708-444-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-12
Last Update Date:2008-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical