Provider Demographics
NPI:1194569962
Name:WILLIAMS, ADIESHA
Entity type:Individual
Prefix:
First Name:ADIESHA
Middle Name:
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 1:5508 ASCENT DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOPEMILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348
Mailing Address - Country:US
Mailing Address - Phone:423-497-9656
Mailing Address - Fax:
Practice Address - Street 1:185 MITTIE HADDOCK DR
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-9379
Practice Address - Country:US
Practice Address - Phone:910-500-7783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TNRBT-23-302936106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician