Provider Demographics
NPI:1881755452
Name:WILLIAMS, MELISSA A (LPC,CSI,CSAC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC,CSI,CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 UNION RD STE A
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2215
Mailing Address - Country:US
Mailing Address - Phone:704-852-3874
Mailing Address - Fax:704-852-7060
Practice Address - Street 1:1558 UNION RD STE A
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2215
Practice Address - Country:US
Practice Address - Phone:704-852-3874
Practice Address - Fax:704-852-7060
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1637101YA0400X
NC2769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102300Medicaid