Provider Demographics
NPI:1154925816
Name:WILLIAMS, AUDREY DESHIELDS (MS, LPC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:DESHIELDS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1987
Mailing Address - Country:US
Mailing Address - Phone:864-707-2167
Mailing Address - Fax:864-707-2168
Practice Address - Street 1:340 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1987
Practice Address - Country:US
Practice Address - Phone:864-707-2167
Practice Address - Fax:864-707-2168
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7668101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional