Provider Demographics
NPI:1952738205
Name:WILLIAMS, JOHN CHANCELLOR (LCAS-A)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHANCELLOR
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-7507
Mailing Address - Country:US
Mailing Address - Phone:336-454-1140
Mailing Address - Fax:336-454-1180
Practice Address - Street 1:725 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-7507
Practice Address - Country:US
Practice Address - Phone:336-454-1140
Practice Address - Fax:336-454-1180
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2900-A101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health