=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669553244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A WILLIAMSON CARE NETWORK, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 N EDGEWORTH ST SUITE 209
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-2182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-273-2110
-----------------------------------------------------
Fax | 336-273-2114
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 16803
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27416-0803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-273-2110
-----------------------------------------------------
Fax | 336-273-2114
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MRS. MONACA MAYE WILLIAMSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-273-2110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | MHL041663
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------