=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609192582
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY ANN WILLIAMS LCMHCS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2010
-----------------------------------------------------
Last Update Date | 07/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 CENTERVIEW DR STE 36
-----------------------------------------------------
City | GREENBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-254-7634
-----------------------------------------------------
Fax | 336-609-6329
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 CENTERVIEW DR. STE 36
-----------------------------------------------------
City | GREENBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-254-7634
-----------------------------------------------------
Fax | 336-609-6329
-----------------------------------------------------
=====================================================
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 | 1600
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 1600LCAS
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | A7828
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LCMHC-SNCS7828
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------