Provider Demographics
NPI:1194995472
Name:WILLIAMS, SHIRLEY ANN (MA, LCAS, CSI)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA, LCAS, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 MEADOWVIEW ROAD APT A-1
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358
Mailing Address - Country:US
Mailing Address - Phone:910-618-9912
Mailing Address - Fax:910-618-0728
Practice Address - Street 1:3750 MEADOWVIEW ROAD APT A-1
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:910-618-9912
Practice Address - Fax:910-618-0728
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1241101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6110549Medicaid