Provider Demographics
NPI:1336518554
Name:WILLIAMS, TRAVIS EDWARD (LCMHC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:EDWARD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 SIX FORKS RD STE 1000
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5738
Mailing Address - Country:US
Mailing Address - Phone:919-578-8110
Mailing Address - Fax:
Practice Address - Street 1:4208 SIX FORKS RD STE 1000
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5738
Practice Address - Country:US
Practice Address - Phone:919-578-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12758101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
47-4898841OtherIRS