Provider Demographics
NPI:1487109179
Name:WILLIAMSON, STACEY MCHENRY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MCHENRY
Last Name:WILLIAMSON
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 1:2115 FOREST HILLS RD W
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3483
Mailing Address - Country:US
Mailing Address - Phone:252-903-9348
Mailing Address - Fax:
Practice Address - Street 1:7019 HARPS MILL RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3248
Practice Address - Country:US
Practice Address - Phone:199-844-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1453237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist