Provider Demographics
NPI:1952772832
Name:WILLIAMS, TAVENIA LASHAWN
Entity Type:Individual
Prefix:MS
First Name:TAVENIA
Middle Name:LASHAWN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4728 WINDBREAK LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-0739
Mailing Address - Country:US
Mailing Address - Phone:919-395-6367
Mailing Address - Fax:919-980-9127
Practice Address - Street 1:4242 SIX FORKS RD STE 1550
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6086
Practice Address - Country:US
Practice Address - Phone:919-395-6367
Practice Address - Fax:919-980-9127
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0122491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical