Provider Demographics
NPI:1689342271
Name:WILLIAMS, KHALANDRA NICOLE (LCSWA)
Entity Type:Individual
Prefix:
First Name:KHALANDRA
Middle Name:NICOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6431
Mailing Address - Country:US
Mailing Address - Phone:910-524-2181
Mailing Address - Fax:
Practice Address - Street 1:1886 NC HWY 133
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NC
Practice Address - Zip Code:28457-8360
Practice Address - Country:US
Practice Address - Phone:910-259-0668
Practice Address - Fax:910-202-9966
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0164581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical