Provider Demographics
NPI:1316734882
Name:WILLIAMS, MARY ALYCE (MS, CCC, SLP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALYCE
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:MS, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 GATEWAY RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-5400
Mailing Address - Country:US
Mailing Address - Phone:843-796-3964
Mailing Address - Fax:843-796-4326
Practice Address - Street 1:121 GATEWAY RD UNIT B
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-5400
Practice Address - Country:US
Practice Address - Phone:843-796-3964
Practice Address - Fax:843-796-4326
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist