Provider Demographics
NPI:1982152765
Name:WILLIAMS, ARDELIA
Entity Type:Individual
Prefix:
First Name:ARDELIA
Middle Name:
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 1:47 W QUEENS WAY STE C
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-4075
Mailing Address - Country:US
Mailing Address - Phone:757-759-7386
Mailing Address - Fax:
Practice Address - Street 1:2019 CUNNINGHAM DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3323
Practice Address - Country:US
Practice Address - Phone:757-759-7386
Practice Address - Fax:757-964-7609
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4745795995171M00000X
VA0179824435171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator