Provider Demographics
NPI:1699124008
Name:WILLIAMS, SAVANNA ASHTON (EDS, NCSP)
Entity type:Individual
Prefix:MS
First Name:SAVANNA
Middle Name:ASHTON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N MENTZER ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-8001
Mailing Address - Country:US
Mailing Address - Phone:605-995-3092
Mailing Address - Fax:
Practice Address - Street 1:110 N MENTZER ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-8001
Practice Address - Country:US
Practice Address - Phone:605-995-3092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD78649-0103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool