Provider Demographics
NPI:1740288893
Name:WILLIAMS, ROSEMARY B (BCCR-LADC)
Entity type:Individual
Prefix:PROF
First Name:ROSEMARY
Middle Name:B
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BCCR-LADC
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:B
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ALCOHOL & DRUG COUNS
Mailing Address - Street 1:2103 LYNDALE AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2734
Mailing Address - Country:US
Mailing Address - Phone:612-529-8874
Mailing Address - Fax:612-529-2050
Practice Address - Street 1:118 VICTORIA ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-7114
Practice Address - Country:US
Practice Address - Phone:651-224-6200
Practice Address - Fax:651-221-0457
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1026269-CDT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6J72RAOtherBLUECROSS&BLUE SHEILD #