Provider Demographics
NPI:1649956582
Name:WILLIAMS, BRANDON (LCMHCA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
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 1:7239 LOCKMONT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-6451
Mailing Address - Country:US
Mailing Address - Phone:704-964-5992
Mailing Address - Fax:
Practice Address - Street 1:709 NORTHEAST DR STE 22
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7425
Practice Address - Country:US
Practice Address - Phone:704-912-4095
Practice Address - Fax:704-943-0512
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18875101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health