Provider Demographics
NPI:1528575578
Name:WILLIAMS, MARTIN JR
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 CELANESE RD APT 212
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-0025
Mailing Address - Country:US
Mailing Address - Phone:803-402-1459
Mailing Address - Fax:704-799-8949
Practice Address - Street 1:1355 E GARRISON BLVD STE A
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5143
Practice Address - Country:US
Practice Address - Phone:980-430-9205
Practice Address - Fax:704-799-8949
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17916101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional