Provider Demographics
NPI:1801217534
Name:WILLIAMS, THEDOSIA
Entity Type:Individual
Prefix:
First Name:THEDOSIA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 FOX COVE LN APT K
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5976
Mailing Address - Country:US
Mailing Address - Phone:336-456-9459
Mailing Address - Fax:
Practice Address - Street 1:5304 FOX COVE LN APT K
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-5976
Practice Address - Country:US
Practice Address - Phone:336-456-9459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-24
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health