Healthcare Provider Details

I. General information

NPI: 1548402936
Provider Name (Legal Business Name): EDWARD WILLIAMS LCPC, LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3218 BELAIR RD
BALTIMORE MD
21213-1259
US

IV. Provider business mailing address

3218 BELAIR RD
BALTIMORE MD
21213-1259
US

V. Phone/Fax

Practice location:
  • Phone: 443-386-9080
  • Fax:
Mailing address:
  • Phone: 443-386-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA1757
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC5988
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: