MEDICARE: IRVIN WILLIAMSON

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	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1538730916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRVIN WILLIAMSON

Provider Business Mailing Address
First Line	:	5014 ALEXANDER VALLEY DR APT 302
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-1542
Country	:	US
Telephone Number	:	336-482-5625
Fax Number	:

Provider Business Practice Location Address
First Line	:	5014 ALEXANDER VALLEY DR APT 302
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-1542
Country	:	US
Telephone Number	:	336-482-5625
Fax Number	:

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

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	07/07/2021

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Directions to “ IRVIN WILLIAMSON ” Practice Location

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