Provider Demographics
NPI:1538334750
Name:WILLIAMS, MYRNA CHRISTINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:CHRISTINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MYRNA
Other - Middle Name:C
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1535 MIDDLEBURG RD
Mailing Address - Street 2:
Mailing Address - City:LAWTEY
Mailing Address - State:FL
Mailing Address - Zip Code:32058-3945
Mailing Address - Country:US
Mailing Address - Phone:718-404-3770
Mailing Address - Fax:
Practice Address - Street 1:1535 MIDDLEBURG RD
Practice Address - Street 2:
Practice Address - City:LAWTEY
Practice Address - State:FL
Practice Address - Zip Code:32058-3945
Practice Address - Country:US
Practice Address - Phone:718-404-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW208481041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical