Healthcare Provider Details

I. General information

NPI: 1679084586
Provider Name (Legal Business Name): WILLIAMS OUTREACH & CONSULTING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 VILLAGE DR STE 5
JACKSONVILLE NC
28546-7060
US

IV. Provider business mailing address

99 VILLAGE DR STE 5
JACKSONVILLE NC
28546-7060
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-3119
  • Fax:
Mailing address:
  • Phone: 910-353-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: TAMEKA TALLIE
Title or Position: DIRECTOR OF OPERATIONS
Credential: MA, MSW, LCSWA
Phone: 910-353-3119