Provider Demographics
NPI:1578619094
Name:WILLIAMS, LEAH R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7306
Mailing Address - Country:US
Mailing Address - Phone:910-392-5074
Mailing Address - Fax:910-681-0837
Practice Address - Street 1:1107 CONGRESSIONAL LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8305
Practice Address - Country:US
Practice Address - Phone:910-392-5074
Practice Address - Fax:910-681-0837
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC000538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002078Medicaid
NC2871569Medicare ID - Type Unspecified