Healthcare Provider Details

I. General information

NPI: 1710389655
Provider Name (Legal Business Name): WILLIAMSON TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 W 3RD AVE
WILLIAMSON WV
25661-3006
US

IV. Provider business mailing address

6183 PASEO DEL NORTE, STE 200
CARLSBAD CA
92011-1155
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-0026
  • Fax: 304-235-0028
Mailing address:
  • Phone: 855-259-2288
  • Fax: 877-552-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number05
License Number StateWV

VIII. Authorized Official

Name: BRIAN PHILLIP FARLEY
Title or Position: VP & SECRETARY
Credential:
Phone: 615-861-6000