Provider Demographics
NPI:1902511421
Name:MARSHALL-WILLIAMS, KENYETTA MONTRECE (LCSW)
Entity Type:Individual
Prefix:
First Name:KENYETTA
Middle Name:MONTRECE
Last Name:MARSHALL-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 1:244 BROOKMANOR CT
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-7131
Mailing Address - Country:US
Mailing Address - Phone:314-299-7981
Mailing Address - Fax:
Practice Address - Street 1:244 BROOKMANOR CT
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-7131
Practice Address - Country:US
Practice Address - Phone:314-299-7981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021004096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health