Provider Demographics
NPI:1194565580
Name:WILLIAMS, CA'TERRIA SHANTRICE (MS, LDN)
Entity type:Individual
Prefix:MISS
First Name:CA'TERRIA
Middle Name:SHANTRICE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1367 STEWARTSTOWN RD APT R14
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-8044
Mailing Address - Country:US
Mailing Address - Phone:678-428-5097
Mailing Address - Fax:
Practice Address - Street 1:1367 STEWARTSTOWN RD APT R14
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-8044
Practice Address - Country:US
Practice Address - Phone:678-428-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1591133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty