Provider Demographics
NPI:1417351008
Name:WILLIAMS, LEAH SELMA (RD, LDN, MPH)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:SELMA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RD, LDN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004145133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered