Provider Demographics
NPI:1679869960
Name:WILLIAMS, LORI ANN (MA,NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA,NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-7334
Mailing Address - Country:US
Mailing Address - Phone:919-794-1038
Mailing Address - Fax:
Practice Address - Street 1:2528 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-7334
Practice Address - Country:US
Practice Address - Phone:919-794-1038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC239377101YP2500X
NC9190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00580149Medicaid