Provider Demographics
NPI:1669749420
Name:LANIER-WILLIAMS, MIA NICHOLE (MFTA)
Entity type:Individual
Prefix:MRS
First Name:MIA
Middle Name:NICHOLE
Last Name:LANIER-WILLIAMS
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 DOGWOOD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8783
Mailing Address - Country:US
Mailing Address - Phone:910-546-1627
Mailing Address - Fax:
Practice Address - Street 1:1035C DIRECTOR CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5996
Practice Address - Country:US
Practice Address - Phone:252-215-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1458106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist