Provider Demographics
NPI:1720318801
Name:WILLIAMS, MARY ANN (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 NW 41ST STREET
Mailing Address - Street 2:D-3
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606
Mailing Address - Country:US
Mailing Address - Phone:352-375-2578
Mailing Address - Fax:352-375-2555
Practice Address - Street 1:2630 NW 41ST ST
Practice Address - Street 2:D-3
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7495
Practice Address - Country:US
Practice Address - Phone:352-375-2578
Practice Address - Fax:352-375-2555
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 6263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health