Healthcare Provider Details

I. General information

NPI: 1588583439
Provider Name (Legal Business Name): OLYMPIA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10805 DOYLE BLVD
MC KENNEY VA
23872-2547
US

IV. Provider business mailing address

10805 DOYLE BLVD
MC KENNEY VA
23872-2547
US

V. Phone/Fax

Practice location:
  • Phone: 252-969-3058
  • Fax:
Mailing address:
  • Phone: 252-969-3058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number20200
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: