Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 256414 | KY |
NPI | 1548929946 |
---|---|
Provider Name | Mackenzie Lynn Williams |
First Address | Calhoun, KY 42327-0654 |
Second Address | Calhoun, KY 42327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2021 |
Last Update Date | 21/01/2022 |