Provider Demographics
NPI:1265183743
Name:WILLIAMS, ASIYA (NCPSS)
Entity type:Individual
Prefix:
First Name:ASIYA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NCPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 STROUD PARK CT APT B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-3177
Mailing Address - Country:US
Mailing Address - Phone:910-262-1247
Mailing Address - Fax:
Practice Address - Street 1:8501 TOWER POINT DR STE B3839
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7849
Practice Address - Country:US
Practice Address - Phone:704-639-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-16
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-8400-01175T00000X
NCHC6277251E00000X
174200000X
231556133NN1002X
NC19784977171M00000X
NC33024115172A00000X
NC172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No251E00000XAgenciesHome Health
No174200000XOther Service ProvidersMeals
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker