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General NPI Number Information
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NPI Number | 1679084586
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Entity Type | Organization
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Legal Business Name | WILLIAMS OUTREACH & CONSULTING INC
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 10/18/2017
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Provider Practice Location Address
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Address Line | 99 VILLAGE DR STE 5
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7060
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Country | US
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Telephone | 910-353-3119
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Fax |
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Provider Business Mailing Address
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Address Line | 99 VILLAGE DR STE 5
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7060
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Country | US
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Telephone | 910-353-3119
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | TAMEKA TALLIE
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Credential | MA, MSW, LCSWA
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Telephone | 910-353-3119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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