Provider Demographics
NPI:1245573849
Name:WILLIAMS, CHANDRA DENISE
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:DENISE
Last Name:WILLIAMS
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 1:7612 BROOKWOOD VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9722
Mailing Address - Country:US
Mailing Address - Phone:980-279-7836
Mailing Address - Fax:
Practice Address - Street 1:7612 BROOKWOOD VALLEY LN
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9722
Practice Address - Country:US
Practice Address - Phone:980-279-7836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY270693101YP2500X
NC17200101YM0800X
101YA0400X
VT068.0135166TELE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)