Provider Demographics
NPI:1033515341
Name:WILLIAMS, CARLA E
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:E
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 1:905 W EDEN CIR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-6910
Mailing Address - Country:US
Mailing Address - Phone:479-409-6167
Mailing Address - Fax:479-587-8703
Practice Address - Street 1:905 W EDEN CIR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-6910
Practice Address - Country:US
Practice Address - Phone:479-409-6167
Practice Address - Fax:479-587-8703
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1585-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical