Provider Demographics
NPI:1205501632
Name:WILLIAMS, KENNETH BRYAN (LCMHCA)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:BRYAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 DELANEY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5263
Mailing Address - Country:US
Mailing Address - Phone:336-264-2420
Mailing Address - Fax:
Practice Address - Street 1:2207 DELANEY DR STE 201
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5263
Practice Address - Country:US
Practice Address - Phone:336-264-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16870101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA16870OtherLCMHC LICSENSE