Provider Demographics
NPI:1225446487
Name:WILLIAMS, ANDREA NICOLE (MSP, SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSP, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5316 ALBERT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-5822
Mailing Address - Country:US
Mailing Address - Phone:843-270-7712
Mailing Address - Fax:
Practice Address - Street 1:7900 MATTHEWS MINT HILL RD
Practice Address - Street 2:115
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-6562
Practice Address - Country:US
Practice Address - Phone:980-237-6226
Practice Address - Fax:980-237-6288
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist