Individual provider Active NPI

Kineta L Williams, LICSW

  • Clinical Social Worker
  • Northport, AL
National Provider Identifier
1972188738
Registry record updated Mar 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
3832C Issued in AL
Practice address
5329 Blackstone LN
Northport, AL 35473-1143
Phone
(985) 705-2991
NPI assigned
Mar 13, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 3832C AL Primary

Addresses

Primary practice location

5329 Blackstone LN
Northport, AL 35473-1143

Mailing address

5329 Blackstone LN
Northport, AL 35473-1143
Phone (985) 705-2991

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
3832CALMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615593600000",
    "number": "1972188738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5329 BLACKSTONE LN",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354731143",
            "telephone_number": "985-705-2991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5329 BLACKSTONE LN",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354731143",
            "telephone_number": "985-705-2991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "KINETA",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-13",
        "last_updated": "2021-03-13",
        "certification_date": "2021-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "3832C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northport, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.