Provider Demographics
NPI:1952001265
Name:WILLIAMS, CARVEN CRIN
Entity Type:Individual
Prefix:
First Name:CARVEN
Middle Name:CRIN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 LOWER GRAGSTON ROAD
Mailing Address - Street 2:
Mailing Address - City:PRICHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25555
Mailing Address - Country:US
Mailing Address - Phone:304-972-3524
Mailing Address - Fax:
Practice Address - Street 1:478 LOWER GRAGSTON ROAD
Practice Address - Street 2:
Practice Address - City:PRICHARD
Practice Address - State:WV
Practice Address - Zip Code:25555
Practice Address - Country:US
Practice Address - Phone:304-972-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker