Provider Demographics
NPI:1235504267
Name:WILLIAMS, KEYANA SHARLENE (LPC)
Entity type:Individual
Prefix:
First Name:KEYANA
Middle Name:SHARLENE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E ACADEMY ST #205
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526
Mailing Address - Country:US
Mailing Address - Phone:919-647-4600
Mailing Address - Fax:
Practice Address - Street 1:602 E ACADEMY ST #205
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526
Practice Address - Country:US
Practice Address - Phone:919-647-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11019101YP2500X
NC11019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional