Provider Demographics
NPI:1356706428
Name:REAVYN WILLIAMSON INTERNATIONAL
Entity type:Organization
Organization Name:REAVYN WILLIAMSON INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR AOS
Authorized Official - Prefix:MS
Authorized Official - First Name:REAVYN
Authorized Official - Middle Name:N
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCA, CRC, MS
Authorized Official - Phone:336-327-1946
Mailing Address - Street 1:133 HERITAGE CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-4779
Mailing Address - Country:US
Mailing Address - Phone:336-327-1946
Mailing Address - Fax:
Practice Address - Street 1:133 HERITAGE CREEK WAY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-4779
Practice Address - Country:US
Practice Address - Phone:336-327-1946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12118251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA12118Medicaid