Provider Demographics
NPI:1558124222
Name:MACWILLIAMS, DARA (LAC)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:MACWILLIAMS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 RHODE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-1928
Mailing Address - Country:US
Mailing Address - Phone:856-816-2984
Mailing Address - Fax:
Practice Address - Street 1:701 WEST AVE STE 202
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-3770
Practice Address - Country:US
Practice Address - Phone:609-399-4717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00118300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist