Provider Demographics
NPI:1770462491
Name:WILLIAMS, LISA C
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 GLOSSY IBIS CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-2231
Mailing Address - Country:US
Mailing Address - Phone:302-563-7318
Mailing Address - Fax:
Practice Address - Street 1:8 THE GRN STE A
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3618
Practice Address - Country:US
Practice Address - Phone:302-563-7318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty