1962728352 NPI number — LESLIE WILLIAMS LCSW, CCTP

Table of content: LESLIE WILLIAMS LCSW, CCTP (NPI 1962728352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962728352 NPI number — LESLIE WILLIAMS LCSW, CCTP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
LESLIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CCTP
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:
1962728352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 W MARKET ST
Provider Second Line Business Mailing Address:
STE 2900
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46204-2954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-434-3255
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2335 MATTHEWS TOWNSHIP PKWY
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
MATTHEWS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28105-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-434-3255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2010

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: 1041C0700X , with the licence number:  0904007269 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C006756 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13604553 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6007532 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 928979 . This is a "AVAILITY" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 000816420001 . This is a "UHC - OPTUM" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 17431 . This is a "BLUE CROSS BLUE SHIELD OF NORTH CAROLINA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5092840 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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