Provider Demographics
NPI:1770121576
Name:WILLIAMS, CARLYN R (MA, LCPC)
Entity type:Individual
Prefix:
First Name:CARLYN
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:CARLYN
Other - Middle Name:
Other - Last Name:VADNAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCPC
Mailing Address - Street 1:1860 W WINCHESTER RD STE 205
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1860 W WINCHESTER RD STE 205
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5317
Practice Address - Country:US
Practice Address - Phone:224-424-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.015415101YP2500X
IL180013978101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional