Provider Demographics
NPI:1912663733
Name:WILLIAMS, DEANNA FAYE (LICSW)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:FAYE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25660 3RD ST W APT 214
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-4587
Mailing Address - Country:US
Mailing Address - Phone:320-496-3835
Mailing Address - Fax:
Practice Address - Street 1:25660 3RD ST W APT 214
Practice Address - Street 2:
Practice Address - City:ZIMMERMAN
Practice Address - State:MN
Practice Address - Zip Code:55398-4587
Practice Address - Country:US
Practice Address - Phone:320-496-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN285271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical