Provider Demographics
NPI:1750558672
Name:WILLIAMS, CAROLYN (CCS)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 BAROID RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-8484
Mailing Address - Country:US
Mailing Address - Phone:501-332-4498
Mailing Address - Fax:501-620-7843
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:SUITE V
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4905
Practice Address - Country:US
Practice Address - Phone:501-321-8200
Practice Address - Fax:501-620-7843
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator