Healthcare Provider Details

I. General information

NPI: 1356266076
Provider Name (Legal Business Name): ANDREAL TIANNA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 ADAMS GRV STE 201
COLUMBIA SC
29203-6957
US

IV. Provider business mailing address

1230 ABBERLY VILLAGE CIR
WEST COLUMBIA SC
29169-2456
US

V. Phone/Fax

Practice location:
  • Phone: 803-767-4832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9825
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: