Provider Demographics
NPI:1053052670
Name:WILLIAMSON, AUTUMN (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 WASHINGTON ST W STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-2348
Mailing Address - Country:US
Mailing Address - Phone:304-539-0342
Mailing Address - Fax:
Practice Address - Street 1:209 WASHINGTON ST W STE 200
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2348
Practice Address - Country:US
Practice Address - Phone:304-539-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00946022104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker