Provider Demographics
NPI:1013564509
Name:WILLIAMS, MADELINE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 MURFREESBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2626
Mailing Address - Country:US
Mailing Address - Phone:844-359-7629
Mailing Address - Fax:615-577-5654
Practice Address - Street 1:619 N 30TH ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4047
Practice Address - Country:US
Practice Address - Phone:270-444-7898
Practice Address - Fax:270-933-1786
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
KY294912103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician