Healthcare Provider Details

I. General information

NPI: 1013894211
Provider Name (Legal Business Name): RENEE WILLIAMSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3137 WRIGHTSVILLE AVE UNIT C
WILMINGTON NC
28403-4111
US

IV. Provider business mailing address

406 LADY BUG LN
WILMINGTON NC
28411-8012
US

V. Phone/Fax

Practice location:
  • Phone: 910-839-8084
  • Fax: 910-946-5799
Mailing address:
  • Phone: 910-839-8084
  • Fax: 910-946-5799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS RENEE EILEEN WILLIAMSON
Title or Position: OWNER/PROVIDER
Credential: LCMHC, NCC
Phone: 910-839-8084