Provider Demographics
NPI:1053600387
Name:WILLIAMS, KELLY A (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4829
Mailing Address - Country:US
Mailing Address - Phone:813-434-3468
Mailing Address - Fax:813-649-6375
Practice Address - Street 1:5318 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-4829
Practice Address - Country:US
Practice Address - Phone:813-434-3468
Practice Address - Fax:813-649-6375
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW66591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical