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Provider Information for 1023639283


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PRISCILLA WILLIAMS MSW, LCSW


Sex: Female

NPI: 1023639283
Last Updated: 2024-02-23
Certification Date: 2020-06-10

Details

NameValue
NPI1023639283
Enumeration Date2020-04-29
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 1202 BROWN BEAR CT.
WENTZVILLE, MO 63385
United States

Phone: 636-336-6035 | Fax:
 
Primary Practice Address 1202 BROWN BEAR CT.
WENTZVILLE, MO 63385
United States

Phone: 636-336-6035 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDMO830083102
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 104100000X - Social Worker ORL14257
No 104100000X - Social Worker MO2023013955
No 104100000X - Social Worker MO2020005861
No 1041C0700X - Social Worker - ClinicalMO2020005861
No 1041C0700X - Social Worker - ClinicalORL14257
No 1041S0200X - Social Worker - SchoolMO2023013955
No 1041S0200X - Social Worker - SchoolORL14257
No 1041S0200X - Social Worker - SchoolMO2020005861
Yes 1041C0700X - Social Worker - ClinicalMO2023013955