Provider Demographics
NPI:1003597410
Name:WILLIAMS, SHAVONDA (MED, LCMHCA)
Entity Type:Individual
Prefix:
First Name:SHAVONDA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MED, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 GATESVILLE DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-8001
Mailing Address - Country:US
Mailing Address - Phone:910-578-8605
Mailing Address - Fax:
Practice Address - Street 1:1023 GATESVILLE DR
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-8001
Practice Address - Country:US
Practice Address - Phone:910-578-8605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health