Basic Information
| Provider Information | |||||||||
| NPI: | 1225288541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | STEPHANNIE | ||||||||
| MiddleName: | RAYE | ||||||||
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| Credential: | CM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 238 SUMMAR DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315418344 | ||||||||
| FaxNumber: | 7319358327 | ||||||||
| Practice Location | |||||||||
| Address1: | 2035 SAINT JOHN AVE | ||||||||
| Address2: | |||||||||
| City: | DYERSBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380242209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315418344 | ||||||||
| FaxNumber: | 7319358327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2008 | ||||||||
| LastUpdateDate: | 04/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.