Provider Demographics
NPI:1740961176
Name:WILLIAMS, MYA (LCSW)
Entity type:Individual
Prefix:
First Name:MYA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MYA
Other - Middle Name:
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1009 BURBERRY DR E APT D
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-7406
Mailing Address - Country:US
Mailing Address - Phone:317-690-3146
Mailing Address - Fax:
Practice Address - Street 1:1009 BURBERRY DR E APT D
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-7406
Practice Address - Country:US
Practice Address - Phone:317-690-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1131561041C0700X
IN34009289A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical