Individual
MR. MARK TIMOTHY WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW,LCSW,LADAC
Contact information
Practice address
3118 FAIRWAY DR, LAS CRUCES, NM 88011-4915
(575) 649-3076
Mailing address
749 SAN YSIDRO RD, LAS CRUCES, NM 88007-5323
(575) 522-2990
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0110541
NM
1041C0700X
Clinical Social Worker
Primary
I-06223
NM
Other
Enumeration date
11/17/2005
Last updated
04/13/2012
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