Healthcare Provider Details

I. General information

NPI: 1497949242
Provider Name (Legal Business Name): STEPHEN CHARLES WILLIAMS LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W PATRICK ST SUITE A
FREDERICK MD
21701-6933
US

IV. Provider business mailing address

219 W PATRICK ST SUITE A
FREDERICK MD
21701-6933
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-3223
  • Fax: 301-662-7921
Mailing address:
  • Phone: 301-662-3223
  • Fax: 301-662-7921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11857
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: