Basic Information
| Provider Information | |||||||||
| NPI: | 1528070430 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMSON | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 AVENUE F NE | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632931121 | ||||||||
| FaxNumber: | 8632916084 | ||||||||
| Practice Location | |||||||||
| Address1: | 2825 FRONTAGE RD HIGHWAY 27 | ||||||||
| Address2: | |||||||||
| City: | SEBRING | ||||||||
| State: | FM | ||||||||
| PostalCode: | 33870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8633855179 | ||||||||
| FaxNumber: | 8632916084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YM0800X | MH5292 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.