Healthcare Provider Details

I. General information

NPI: 1053222505
Provider Name (Legal Business Name): PATRICE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W MEDICAL CT
MARION NC
28752-5564
US

IV. Provider business mailing address

500 ARCHDALE DR
CHARLOTTE NC
28217-4217
US

V. Phone/Fax

Practice location:
  • Phone: 828-659-3966
  • Fax:
Mailing address:
  • Phone: 704-332-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: