Healthcare Provider Details

I. General information

NPI: 1023503828
Provider Name (Legal Business Name): IESHA TERESA LEE WILLIAMS LCMHC, LCAS-A,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19901 W CATAWBA AVE STE 102
CORNELIUS NC
28031-4040
US

IV. Provider business mailing address

PO BOX 748465
ATLANTA GA
30374-8465
US

V. Phone/Fax

Practice location:
  • Phone: 980-217-8678
  • Fax:
Mailing address:
  • Phone: 855-284-7483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA13797
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA13797
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13797
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: