Provider Demographics
NPI:1861558322
Name:WILLIAMS, DOLAN DWIGHT (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:DOLAN
Middle Name:DWIGHT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WANDA DR
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-9317
Mailing Address - Country:US
Mailing Address - Phone:919-222-1857
Mailing Address - Fax:919-736-4031
Practice Address - Street 1:2404 MONTGOMERY DR SW STE E
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4462
Practice Address - Country:US
Practice Address - Phone:252-234-2008
Practice Address - Fax:919-899-6300
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0044351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003280Medicaid
NC6003022Medicaid
NC2879433AMedicare ID - Type UnspecifiedPERSONAL PRIVATE PRACTICE