Provider Demographics
NPI:1679673800
Name:WILLIAMS, KAREN JANEEN (PSY D, LCMHC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JANEEN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSY D, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 FRANKLIN CT
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-9609
Mailing Address - Country:US
Mailing Address - Phone:704-915-2777
Mailing Address - Fax:980-938-8533
Practice Address - Street 1:411 CHERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3651
Practice Address - Country:US
Practice Address - Phone:704-669-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5057101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102911Medicaid