Provider Demographics
NPI:1831846971
Name:WILLIAMS, COREY M
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:
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 4481
Mailing Address - Street 2:
Mailing Address - City:ROLLINGBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98061-0481
Mailing Address - Country:US
Mailing Address - Phone:360-908-0053
Mailing Address - Fax:
Practice Address - Street 1:10355 NE VALLEY RD UNIT 4481
Practice Address - Street 2:
Practice Address - City:ROLLINGBAY
Practice Address - State:WA
Practice Address - Zip Code:98061-0020
Practice Address - Country:US
Practice Address - Phone:360-908-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61651444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health