Provider Demographics
NPI:1982836995
Name:WILLIAMS, LATINA GAY (LCAS LCMHCS CCS)
Entity Type:Individual
Prefix:MS
First Name:LATINA
Middle Name:GAY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCAS LCMHCS CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W FIRE TOWER RD # B
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9475
Mailing Address - Country:US
Mailing Address - Phone:252-814-9160
Mailing Address - Fax:
Practice Address - Street 1:104 W FIRE TOWER RD # B
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-9475
Practice Address - Country:US
Practice Address - Phone:252-814-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1508101YA0400X
NC7889101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health