Healthcare Provider Details

I. General information

NPI: 1265741904
Provider Name (Legal Business Name): A PLUS WILLIAMSON CARE NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N EDGEWORTH ST STE 209
GREENSBORO NC
27401-2071
US

IV. Provider business mailing address

415 N EDGEWORTH ST STE 209
GREENSBORO NC
27401-2071
US

V. Phone/Fax

Practice location:
  • Phone: 336-558-3749
  • Fax:
Mailing address:
  • Phone: 336-274-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. MONACA MAYE WILLIAMSON
Title or Position: DIRECTOR OF OPERATIONS
Credential: BS QDDP
Phone: 336-558-3749