Provider Demographics
NPI:1801660865
Name:WILLIAMS, XAVEIRA (LMBT)
Entity type:Individual
Prefix:
First Name:XAVEIRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6506 DENTAL LN STE 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0383
Mailing Address - Country:US
Mailing Address - Phone:910-487-3002
Mailing Address - Fax:
Practice Address - Street 1:6506 DENTAL LN STE 102
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0383
Practice Address - Country:US
Practice Address - Phone:910-487-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17043225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist