Provider Demographics
NPI:1275251555
Name:WILLIAMS, SIDNEE (LCSWA)
Entity Type:Individual
Prefix:
First Name:SIDNEE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BATTLEGROUND AVE STE 209E
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8028
Mailing Address - Country:US
Mailing Address - Phone:336-383-1665
Mailing Address - Fax:
Practice Address - Street 1:1400 BATTLEGROUND AVE STE 209E
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8028
Practice Address - Country:US
Practice Address - Phone:336-383-1665
Practice Address - Fax:336-383-1665
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0181891041C0700X
NCPO181891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC833557264Medicaid