Healthcare Provider Details

I. General information

NPI: 1710639042
Provider Name (Legal Business Name): WILLIAMS RESTORATION OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 12/13/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 W BALTIMORE ST 1ST FLOOR
BALTIMORE MD
21223-2402
US

IV. Provider business mailing address

1335 W BALTIMORE ST
BALTIMORE MD
21223-2402
US

V. Phone/Fax

Practice location:
  • Phone: 443-869-2297
  • Fax: 443-869-2326
Mailing address:
  • Phone: 443-869-2297
  • Fax: 443-869-2326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: EDWARD WILLIAMS
Title or Position: CEO
Credential: LCPC LCADC
Phone: 443-386-9080