MEDICARE: CASSANDRA WILLIAMS LGPC, CSC-AD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	SC2465	MD
2	101YM0800X	Mental Health Counselor	LGP13870	MD

General Provider Information

NPI Number	:	1336905678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA WILLIAMS LGPC, CSC-AD

Provider Business Mailing Address
First Line	:	10310 POPES CREEK RD
Second Line	:
City	:	NEWBURG
State	:	MD
Zip	:	20664-2128
Country	:	US
Telephone Number	:	240-444-6186
Fax Number	:

Provider Business Practice Location Address
First Line	:	10310 POPES CREEK RD
Second Line	:
City	:	NEWBURG
State	:	MD
Zip	:	20664-2128
Country	:	US
Telephone Number	:	240-444-6186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2024
Last Update Date	:	02/23/2024

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