Provider Demographics
NPI:1255692919
Name:TRAUMA ASSESSMENT & TREATMENT CENTER, PLLC
Entity Type:Organization
Organization Name:TRAUMA ASSESSMENT & TREATMENT CENTER, PLLC
Other - Org Name:LESLIE L. WILLIAMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LCSW, CCTP/ CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CCTP
Authorized Official - Phone:704-921-9943
Mailing Address - Street 1:8531 RIDGELINE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8000
Mailing Address - Country:US
Mailing Address - Phone:704-921-9943
Mailing Address - Fax:704-665-1959
Practice Address - Street 1:1914 J N PEASE PL STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4504
Practice Address - Country:US
Practice Address - Phone:704-921-9943
Practice Address - Fax:704-665-1959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0067561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007532Medicaid
NC5092840OtherAETNA
NC928979OtherAVAILITY
NC13604553OtherCIGNA
NC000816420001OtherUHC-OPTUM
NC02GFQOtherBLUE CROSS AND BLUE SHIELD OF NC