Provider Demographics
NPI:1356864508
Name:LEAH WILLIAMS NUTRITION LLC
Entity Type:Organization
Organization Name:LEAH WILLIAMS NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:SELMA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-564-8900
Mailing Address - Street 1:209 E CARVER ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2133
Mailing Address - Country:US
Mailing Address - Phone:919-564-8900
Mailing Address - Fax:
Practice Address - Street 1:209 E CARVER ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2133
Practice Address - Country:US
Practice Address - Phone:919-564-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004145133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty