Provider Demographics
NPI:1992746226
Name:WILLIAMS, LETA C (LISW)
Entity type:Individual
Prefix:MRS
First Name:LETA
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 DELLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-5017
Mailing Address - Country:US
Mailing Address - Phone:864-232-9334
Mailing Address - Fax:864-232-9335
Practice Address - Street 1:336 DELLWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-5017
Practice Address - Country:US
Practice Address - Phone:864-232-9334
Practice Address - Fax:864-232-9335
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42251041C0700X
SCSC42251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q318121272Medicare ID - Type Unspecified
SCQ31812Medicare UPIN
SCQ31812Medicare PIN