Provider Demographics
NPI:1831190438
Name:WILLIAMS, RONALD (LCSW, CADAC II)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCSW, CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2556
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46904-2556
Mailing Address - Country:US
Mailing Address - Phone:765-453-4500
Mailing Address - Fax:765-453-4525
Practice Address - Street 1:1531 ROCKFORD CT
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3207
Practice Address - Country:US
Practice Address - Phone:765-453-4500
Practice Address - Fax:765-453-4500
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004977A1041C0700X, 1041C0700X
INT299101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000533182OtherANTHEM PIN
IN111810LLLMedicare PIN