Healthcare Provider Details

I. General information

NPI: 1639027451
Provider Name (Legal Business Name): MR. PACO WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 BIRKDALE CT
FAYETTEVILLE NC
28303-4684
US

IV. Provider business mailing address

3520 BIRKDALE CT
FAYETTEVILLE NC
28303-4684
US

V. Phone/Fax

Practice location:
  • Phone: 910-882-7219
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024045
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: