Provider Demographics
NPI:1770907248
Name:WILLIAMS-FALCON, KRIS F (PHD, CPASTC, MSW,SAC)
Entity type:Individual
Prefix:DR
First Name:KRIS
Middle Name:F
Last Name:WILLIAMS-FALCON
Suffix:
Gender:F
Credentials:PHD, CPASTC, MSW,SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5660 HANCOCK STREET
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-9279
Mailing Address - Country:US
Mailing Address - Phone:912-988-1908
Mailing Address - Fax:877-519-9594
Practice Address - Street 1:207 WIND SWEPT ST
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-9279
Practice Address - Country:US
Practice Address - Phone:912-988-1908
Practice Address - Fax:877-519-9597
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02155627 DUAL101YP1600X, 106H00000X
GA02155627101YP1600X, 106H00000X
101YP2500X, 101YM0800X, 101Y00000X
NC960065254103K00000X
GA80056542104100000X
NC21418975101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
12709963OtherCAQH