Healthcare Provider Details

I. General information

NPI: 1780912238
Provider Name (Legal Business Name): CARRIE WILLIAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 PROFESSIONAL COURT SUITE 400
MOORESVILLE NC
28117-5600
US

IV. Provider business mailing address

134 PROFESSIONAL COURT, SUITE 400
MOORESVILLE NC
28117-5600
US

V. Phone/Fax

Practice location:
  • Phone: 704-664-1009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005379
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: