Provider Demographics
NPI:1891963856
Name:WILLIAMS, BRENDA SMITH (CCS)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SMITH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5408
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27435-0408
Mailing Address - Country:US
Mailing Address - Phone:336-312-4517
Mailing Address - Fax:
Practice Address - Street 1:620 MARTIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-1741
Practice Address - Country:US
Practice Address - Phone:336-273-5306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC305101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)