Provider Demographics
NPI:1104608405
Name:WILLIAMS, ANNA REBECCA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:REBECCA
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 1:114 S CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1845
Mailing Address - Country:US
Mailing Address - Phone:704-305-9367
Mailing Address - Fax:
Practice Address - Street 1:5101 DUNLEA CT STE 201C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-4436
Practice Address - Country:US
Practice Address - Phone:910-502-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician