Provider Demographics
NPI:1427513829
Name:WILLIAMSON, ROILENE MICHIKO MIYAGAWA (LMFTA)
Entity type:Individual
Prefix:
First Name:ROILENE
Middle Name:MICHIKO MIYAGAWA
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:ROILENE
Other - Middle Name:MICHIKO
Other - Last Name:MIYAGAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 BOYD LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7205
Mailing Address - Country:US
Mailing Address - Phone:253-268-9448
Mailing Address - Fax:
Practice Address - Street 1:2525 RAEFORD RD STE C
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5092
Practice Address - Country:US
Practice Address - Phone:253-268-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12127A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist