Provider Demographics
NPI:1093413213
Name:WILLIAMS, KELLEY M (LICSW)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:M
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 1:615 BROOKLANE DR UNIT 3194
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-4007
Mailing Address - Country:US
Mailing Address - Phone:205-586-1007
Mailing Address - Fax:
Practice Address - Street 1:615 BROOKLANE DR UNIT 3194
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-4007
Practice Address - Country:US
Practice Address - Phone:205-586-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5025C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical