MEDICARE: KISHIA WILLIAMS LCSWA,LCASA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P011193	NC

General Provider Information

NPI Number	:	1538556048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISHIA WILLIAMS LCSWA,LCASA

Provider Business Mailing Address
First Line	:	1734 BOROS DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-3081
Country	:	US
Telephone Number	:	910-494-1583
Fax Number	:

Provider Business Practice Location Address
First Line	:	1734 BOROS DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-3081
Country	:	US
Telephone Number	:	910-494-1583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	01/30/2017

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