Provider Demographics
NPI:1336559400
Name:WILLIAMS, CRISTEN (MED, MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CRISTEN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MED, MSW, LCSW
Other - Prefix:
Other - First Name:CRISTEN
Other - Middle Name:
Other - Last Name:ROGGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:613 SHIPYARD BLVD
Mailing Address - Street 2:UNIT 102
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6492
Mailing Address - Country:US
Mailing Address - Phone:910-777-9670
Mailing Address - Fax:910-202-5772
Practice Address - Street 1:613 SHIPYARD BLVD
Practice Address - Street 2:UNIT 102
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6492
Practice Address - Country:US
Practice Address - Phone:910-777-9670
Practice Address - Fax:910-202-5772
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0100351041C0700X
NCP0086371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical