Provider Demographics
NPI:1972257467
Name:MACE ANTHONY WILLIAMSON FOUNDATION
Entity Type:Organization
Organization Name:MACE ANTHONY WILLIAMSON FOUNDATION
Other - Org Name:THE MACE ANTHONY WILLIAMSON FOUNDATION
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MAIYE
Authorized Official - Middle Name:TA'KIYAH
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:DOULA
Authorized Official - Phone:727-253-7729
Mailing Address - Street 1:111 2ND AVE NE STE 360
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3580
Mailing Address - Country:US
Mailing Address - Phone:727-253-7729
Mailing Address - Fax:
Practice Address - Street 1:111 2ND AVE NE STE 360
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3580
Practice Address - Country:US
Practice Address - Phone:727-253-7729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical