=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154219798
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETHANEY CHRISTA WILLIAMS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2025
-----------------------------------------------------
Last Update Date | 06/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8362 SIX FORKS RD STE 104
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27615-5086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-583-7910
-----------------------------------------------------
Fax | 919-278-2647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8362 SIX FORKS RD STE 104
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27615-5086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-222-4162
-----------------------------------------------------
Fax | 919-278-2647
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------