Provider Demographics
NPI:1912151010
Name:WILLIAMS, MISTI (MS, LCGC)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6827 DUNKARD RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-5645
Mailing Address - Country:US
Mailing Address - Phone:615-500-9526
Mailing Address - Fax:
Practice Address - Street 1:1900 ELECTRIC ROAD
Practice Address - Street 2:LEWISGALE CLINICAL GENETICS
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-0001
Practice Address - Country:US
Practice Address - Phone:540-776-4963
Practice Address - Fax:540-725-5018
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS