Provider Demographics
NPI:1992276075
Name:WILLIAMS, STEPHANIE LOU'ELLEN (MAED)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LOU'ELLEN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 LANDSCAPE RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-7127
Mailing Address - Country:US
Mailing Address - Phone:606-316-1888
Mailing Address - Fax:
Practice Address - Street 1:509 LANDSCAPE RD
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-7127
Practice Address - Country:US
Practice Address - Phone:606-316-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYNA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health