Provider Demographics
NPI:1417511247
Name:WILLIAMSON, OLIVIA (RBT)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 STEAMBOAT SPRINGS AVE # 2418
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5429
Mailing Address - Country:US
Mailing Address - Phone:919-692-5385
Mailing Address - Fax:
Practice Address - Street 1:3317 MASONBORO LOOP RD UNIT 150
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-2970
Practice Address - Country:US
Practice Address - Phone:910-599-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty