1881732220 NPI number — MR. CLINTON MCCRAY WILLIAMS LCMHCS

Table of content: MR. CLINTON MCCRAY WILLIAMS LCMHCS (NPI 1881732220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881732220 NPI number — MR. CLINTON MCCRAY WILLIAMS LCMHCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
CLINTON
Provider Middle Name:
MCCRAY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCMHCS
Provider Gender Code:
M

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:
1881732220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX M
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARYSBURG
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27831-0330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-532-6570
Provider Business Mailing Address Fax Number:
252-537-4005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELDON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27890-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
522-537-4005
Provider Business Practice Location Address Fax Number:
252-537-0329
Provider Enumeration Date:
02/01/2007

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: 101YP2500X , with the licence number:  4547 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 4547 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6102064 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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