Provider Demographics
NPI:1306887385
Name:WILLIAMS, VICKI (LCSW)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CRANES ROOST CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3650
Mailing Address - Country:US
Mailing Address - Phone:270-765-2605
Mailing Address - Fax:
Practice Address - Street 1:65 OLD SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-9185
Practice Address - Country:US
Practice Address - Phone:270-692-2509
Practice Address - Fax:270-692-2592
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000386663OtherANTHEM
KY30605018Medicaid
11574943OtherCAQH
KY373347OtherTRICARE
KY0358995Medicare ID - Type UnspecifiedMEDICARE
0358793Medicare ID - Type Unspecified
KY373347OtherTRICARE
KY0359293Medicare ID - Type UnspecifiedMEDICARE
KY0762238Medicare ID - Type UnspecifiedMEDICARE
KY0974709Medicare ID - Type UnspecifiedMEDICARE
KY30605018Medicaid
KY0762336Medicare ID - Type UnspecifiedMEDICARE
KY0358895Medicare ID - Type UnspecifiedMEDICARE
KY0358693Medicare ID - Type UnspecifiedMEDICARE
KY0359095Medicare ID - Type UnspecifiedMEDICARE