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Individual

MYRNA B. WILLIAMS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
1530 MARTIN ST, SUITE 203, WINSTON SALEM, NC 27103-4936
(336) 748-9114
(336) 748-1040
Mailing address
PO BOX 5052, WINSTON SALEM, NC 27113-5052
(336) 748-9114
(336) 748-1040

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0953
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
03764
BLUE CROSS/BLUE SHIELD
NC
05
6000153
NC
Enumeration date
07/21/2007
Last updated
07/21/2007
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