Provider Demographics
NPI:1871166744
Name:WILLIAMS, AMELIA WALL (MA)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:WALL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 PINFISH LN UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-5627
Mailing Address - Country:US
Mailing Address - Phone:828-390-2961
Mailing Address - Fax:
Practice Address - Street 1:18676 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-4049
Practice Address - Country:US
Practice Address - Phone:910-821-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2203221235Z00000X
NC30000500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist