Healthcare Provider Details

I. General information

NPI: 1669749420
Provider Name (Legal Business Name): MIA NICHOLE LANIER-WILLIAMS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 N HERRITAGE ST STE A
KINSTON NC
28501-1580
US

IV. Provider business mailing address

1183 DOGWOOD RIDGE DR
WINTERVILLE NC
28590-8783
US

V. Phone/Fax

Practice location:
  • Phone: 252-686-5020
  • Fax:
Mailing address:
  • Phone: 910-546-1627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1458
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: