Williams, Connie S

Williams, Connie S is an individual health care provider with primary practice located at 302 W Main St , Fairborn OH 45324-5037. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Williams, Connie S can be contacted via phone (937) 281-4673.

Contact Information

Primary practice address
302 W Main St Fairborn OH 45324-5037
Phone: (937) 281-4673
Fax: (937) 318-1120
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X LSW S 0005246 Ohio
Behavioral Health & Social Service Providers / Clinical 1041C0700X I.0800334-SUPV Ohio

Profile Details

NPI number 1497737050
LBN Legal business name Williams, Connie S
Credentials LISW-SUPV
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 18th, 2005
Last updated Oct 5th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497737050 NPPES
Ohio MEDICAID 2272231

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