Provider Demographics
NPI:1740622356
Name:EADS, WILLIAM WEBSTER (MDIV)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WEBSTER
Last Name:EADS
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 571097
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-1097
Mailing Address - Country:US
Mailing Address - Phone:336-716-0848
Mailing Address - Fax:336-716-0822
Practice Address - Street 1:131 W LEBANON ST
Practice Address - Street 2:SUITE C&E
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2935
Practice Address - Country:US
Practice Address - Phone:336-786-1922
Practice Address - Fax:336-786-1923
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral