1225446487 NPI number — ANDREA NICOLE WILLIAMS M.S.P, SLP

Table of content: ANDREA NICOLE WILLIAMS M.S.P, SLP (NPI 1225446487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225446487 NPI number — ANDREA NICOLE WILLIAMS M.S.P, SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
ANDREA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.P, SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225446487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5316 ALBERT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29418-5822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-270-7712
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7900 MATTHEWS MINT HILL RD
Provider Second Line Business Practice Location Address:
115
Provider Business Practice Location Address City Name:
MINT HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28227-6562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-237-6226
Provider Business Practice Location Address Fax Number:
980-237-6288
Provider Enumeration Date:
07/31/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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