Healthcare Provider Details

I. General information

NPI: 1598343295
Provider Name (Legal Business Name): SHANNON WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PALMETTO PARK BLVD
LEXINGTON SC
29072-7852
US

IV. Provider business mailing address

1111 BELLEVIEW ST STE 101
COLUMBIA SC
29201-1868
US

V. Phone/Fax

Practice location:
  • Phone: 803-756-1000
  • Fax:
Mailing address:
  • Phone: 803-758-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: