Provider Demographics
NPI:1831246081
Name:WILLIAMS, MAXINE C (MSW, CSW)
Entity type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627A ENSIGN RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5024
Mailing Address - Country:US
Mailing Address - Phone:360-455-1322
Mailing Address - Fax:360-455-1322
Practice Address - Street 1:3627A ENSIGN RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5024
Practice Address - Country:US
Practice Address - Phone:360-455-1322
Practice Address - Fax:360-455-1322
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000048961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical