=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114434610
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAROLD WILLIAMS MHS,LCADC,CCS,CSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2018
-----------------------------------------------------
Last Update Date | 04/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 227 BROADWAY
-----------------------------------------------------
City | WESTVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08093-1151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-637-3144
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 20
-----------------------------------------------------
City | WESTVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08093-0020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-637-3144
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 37LC00061200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------