Provider Demographics
NPI:1053041756
Name:WILLIAMS, MAC (BA)
Entity type:Individual
Prefix:
First Name:MAC
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PEMBROKE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6404
Mailing Address - Country:US
Mailing Address - Phone:724-396-1510
Mailing Address - Fax:724-972-4627
Practice Address - Street 1:129 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-7063
Practice Address - Country:US
Practice Address - Phone:724-396-1510
Practice Address - Fax:724-972-4627
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2204095-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty