Healthcare Provider Details

I. General information

NPI: 1932447711
Provider Name (Legal Business Name): MR. DAVID EMERSON WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 GARNER RD STE 103
RALEIGH NC
27610-4687
US

IV. Provider business mailing address

2101 GARNER RD STE 103
RALEIGH NC
27610-4687
US

V. Phone/Fax

Practice location:
  • Phone: 919-832-4457
  • Fax: 919-829-1357
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3109-A
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3109
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: