Provider Demographics
NPI:1831549237
Name:WILLIAMS, BRIANA L (LCSW, SAC)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW, SAC
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:LYNN
Other - Last Name:TIMRECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1612 EAST STREET
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241
Mailing Address - Country:US
Mailing Address - Phone:920-905-5994
Mailing Address - Fax:
Practice Address - Street 1:1612 EAST ST
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-3054
Practice Address - Country:US
Practice Address - Phone:920-905-5994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16120-131101YA0400X
1041C0700X
WI8592-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1831549237Medicaid
WI1831549237Medicaid
WIK400330800Medicare PIN