Healthcare Provider Details

I. General information

NPI: 1912107582
Provider Name (Legal Business Name): JENNIFER WILLIAMS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER WALTON LCPC, LPC

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16701 MELFORD BLVD STE 400
BOWIE MD
20715-4411
US

IV. Provider business mailing address

2703 WOODLAKE RD
BOWIE MD
20721-2567
US

V. Phone/Fax

Practice location:
  • Phone: 202-743-0072
  • Fax:
Mailing address:
  • Phone: 718-757-2364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: