Provider Demographics
NPI:1699169094
Name:WILLIAMS, WILLIE E (PHD, MA)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:PHD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TORRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8796
Mailing Address - Country:US
Mailing Address - Phone:803-479-2706
Mailing Address - Fax:803-699-9285
Practice Address - Street 1:10 TORRINGTON CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8796
Practice Address - Country:US
Practice Address - Phone:803-479-2706
Practice Address - Fax:803-699-9285
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC405127Medicaid
SC3343Medicare PIN