Active NPI
Anthony Williams, LCDC
- Addiction (Substance Use Disorder) Counselor
- St Petersburg, FL
National Provider Identifier
1083073068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 4280 A
- Practice address
- 2709 17TH St S
St Petersburg, FL 33712-3603 - Phone
- (512) 731-4947
- NPI assigned
- Feb 18, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 8262 | TX | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 901 | GA | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 4280 A | FL | Primary |
| Massage Therapist | 225700000X | MT105186 | TX |
Addresses
Primary practice location
2709 17TH St S
St Petersburg, FL 33712-3603
Mailing address
2709 17TH St S
St Petersburg, FL 33712-3603
Phone (512) 731-4947
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8262 | Other | TX | LCDC |
| 4280 A | Other | FL | CAC |
| 901 | Other | GA | CADC-I |
| 105186 | Other | TX | LMT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4280 A | FL | MD | Addiction (Substance Use Disorder) Counselor |
| 901 | GA | MD | Addiction (Substance Use Disorder) Counselor |
| 8262 | TX | MD | Addiction (Substance Use Disorder) Counselor |
| MT105186 | TX | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455840000000",
"number": "1083073068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2709 17TH ST S",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337123603",
"telephone_number": "512-731-4947"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2709 17TH ST S",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337123603",
"telephone_number": "512-731-4947"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "ANTHONY",
"credential": "LCDC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-02-18",
"last_updated": "2016-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "8262",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "GA",
"license": "901",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "FL",
"license": "4280 A",
"primary": true
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "TX",
"license": "MT105186",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCDC",
"identifier": "8262",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAC",
"identifier": "4280 A",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CADC-I",
"identifier": "901",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LMT",
"identifier": "105186",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.