Basic Information
| Provider Information | |||||||||
| NPI: | 1538407390 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | EUGENIA | ||||||||
| MiddleName: | ROSETTA | ||||||||
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| Credential: | LCAS-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 COPPERFIELD BLVD NE | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047823131 | ||||||||
| FaxNumber: | 7047823133 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 COPPERFIELD BLVD NE | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047823131 | ||||||||
| FaxNumber: | 7047823133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2013 | ||||||||
| LastUpdateDate: | 01/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCAS-20959 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.