Provider Demographics
NPI:1609918176
Name:WILLIAMS, AMY JOHNSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:JOHNSON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SILAS CREEK PARKWAY
Mailing Address - Street 2:SUITE 1 A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-722-7300
Mailing Address - Fax:336-722-7311
Practice Address - Street 1:2200 SILAS CREEK PARKWAY
Practice Address - Street 2:SUITE 1 A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-722-7300
Practice Address - Fax:336-722-7311
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2807101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890294KMedicaid
NC890294KMedicaid