Provider Demographics
NPI:1902638224
Name:WILLIAMS, JOELLE (LMSW)
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JOELLE
Other - Middle Name:
Other - Last Name:BLAKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3163 FORT SAMUEL CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-3819
Mailing Address - Country:US
Mailing Address - Phone:314-681-7902
Mailing Address - Fax:
Practice Address - Street 1:913 S 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-3120
Practice Address - Country:US
Practice Address - Phone:314-681-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230107521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical