Provider Demographics
NPI:1750627287
Name:WILLIAMS, LEE MARTIN SR (LCSW, SUDC)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:MARTIN
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:LCSW, SUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 E 1800 N
Mailing Address - Street 2:
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2019
Mailing Address - Country:US
Mailing Address - Phone:435-213-3062
Mailing Address - Fax:
Practice Address - Street 1:186 E. 1800 N.
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341
Practice Address - Country:US
Practice Address - Phone:435-213-3062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8132029-6006101YA0400X
UT8132029-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)