Provider Demographics
NPI:1114558558
Name:WILLIAMSON, VONDA KAY
Entity Type:Individual
Prefix:MRS
First Name:VONDA
Middle Name:KAY
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E STONE AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-5655
Mailing Address - Country:US
Mailing Address - Phone:864-534-1804
Mailing Address - Fax:864-534-1805
Practice Address - Street 1:217 E STONE AVE STE 8
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-5655
Practice Address - Country:US
Practice Address - Phone:864-534-1804
Practice Address - Fax:864-534-1805
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health