Provider Demographics
NPI:1881732220
Name:WILLIAMS, CLINTON MCCRAY (LCMHCS)
Entity type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:MCCRAY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX M
Mailing Address - Street 2:
Mailing Address - City:GARYSBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27831-0330
Mailing Address - Country:US
Mailing Address - Phone:252-532-6570
Mailing Address - Fax:252-537-4005
Practice Address - Street 1:100 ELM ST
Practice Address - Street 2:
Practice Address - City:WELDON
Practice Address - State:NC
Practice Address - Zip Code:27890-1934
Practice Address - Country:US
Practice Address - Phone:522-537-4005
Practice Address - Fax:252-537-0329
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4547101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102064Medicaid