Healthcare Provider Details

I. General information

NPI: 1205383353
Provider Name (Legal Business Name): MYCHELLE WILLIAMS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 12/02/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

IV. Provider business mailing address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

V. Phone/Fax

Practice location:
  • Phone: 301-892-6650
  • Fax:
Mailing address:
  • Phone: 301-892-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC14909
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC14909
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: