Provider Demographics
NPI:1699014076
Name:AMELIA P. WILLIAMS
Entity Type:Organization
Organization Name:AMELIA P. WILLIAMS
Other - Org Name:COMMUNITY LINK COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:919-264-5332
Mailing Address - Street 1:349 TECHNICAL CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2873
Mailing Address - Country:US
Mailing Address - Phone:919-264-5332
Mailing Address - Fax:188-831-6369
Practice Address - Street 1:349 TECHNICAL CT
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-2873
Practice Address - Country:US
Practice Address - Phone:919-264-5332
Practice Address - Fax:188-831-6369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5053101Y00000X, 101YM0800X
NC151803102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916159Medicaid
NC6008274Medicaid
NC6104973Medicaid
NC6102867Medicaid