MEDICARE: CHANDRA DENISE WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	270693	KY
2	101YM0800X	Mental Health Counselor	17200	NC
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	101YM0800X	Mental Health Counselor	068.0135166TELE	VT

General Provider Information

NPI Number	:	1245573849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDRA DENISE WILLIAMS

Provider Business Mailing Address
First Line	:	7612 BROOKWOOD VALLEY LN
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-9722
Country	:	US
Telephone Number	:	980-279-7836
Fax Number	:

Provider Business Practice Location Address
First Line	:	7612 BROOKWOOD VALLEY LN
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-9722
Country	:	US
Telephone Number	:	980-279-7836
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2013
Last Update Date	:	04/20/2023

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