Provider Demographics
NPI:1528133311
Name:WILLIAMS, ELLOUISE EILEEN (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELLOUISE
Middle Name:EILEEN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ARLAN ENTERPRISES, INC.
Mailing Address - Street 2:3139 BENT CREEK DRIVE
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-8290
Mailing Address - Country:US
Mailing Address - Phone:813-240-3948
Mailing Address - Fax:813-643-4908
Practice Address - Street 1:4316 NEW RIVER HILLS PKWY
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-8212
Practice Address - Country:US
Practice Address - Phone:813-240-3948
Practice Address - Fax:813-643-4908
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 16241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
593416974OtherEIN ARLAN ENTERPRISES INC