Provider Demographics
NPI:1558452383
Name:WILLIAMS, RODNEY PHILLIP (LCSW)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:PHILLIP
Last Name:WILLIAMS
Suffix:
Gender:M
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:PO BOX 11807
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38308-0130
Mailing Address - Country:US
Mailing Address - Phone:731-664-3500
Mailing Address - Fax:
Practice Address - Street 1:36 SANDSTONE CIR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2098
Practice Address - Country:US
Practice Address - Phone:731-664-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4049291OtherBLUE CROSS BLUE SHIELD #
TN4049291OtherBLUE CROSS BLUE SHIELD #