Healthcare Provider Details

I. General information

NPI: 1699014076
Provider Name (Legal Business Name): AMELIA P. WILLIAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 BEAUFAIN ST
RALEIGH NC
27604-5074
US

IV. Provider business mailing address

4108 BEAUFAIN ST
RALEIGH NC
27604-5074
US

V. Phone/Fax

Practice location:
  • Phone: 919-200-9633
  • Fax:
Mailing address:
  • Phone: 919-200-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number151803
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5053
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5053
License Number StateNC

VIII. Authorized Official

Name: DR. AMELIA P WILLIAMS
Title or Position: CEO
Credential: PHD, LPC
Phone: 919-264-5332