Provider Demographics
NPI:1013191279
Name:WILLIAMS, CAROLINE B (PHD, MP)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:B
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ESCALERA CIR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2963
Mailing Address - Country:US
Mailing Address - Phone:575-779-4401
Mailing Address - Fax:800-866-8791
Practice Address - Street 1:BROOKE ARMY MEDICAL CENTER
Practice Address - Street 2:3551 ROGER BROOKE DR
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:706-304-3010
Practice Address - Fax:800-866-8791
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0911103TC0700X
NM00911103TP0016X
NM20103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14880300Medicaid