Healthcare Provider Details

I. General information

NPI: 1801195581
Provider Name (Legal Business Name): JACQUELINE WILLIAMS LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 09/21/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MEDICAL CENTER DR STE 230B
LARGO MD
20774-3707
US

IV. Provider business mailing address

14313 LUSBY RIDGE ROAD
ACCOKEEK MD
20607
US

V. Phone/Fax

Practice location:
  • Phone: 240-535-8013
  • Fax: 240-437-4117
Mailing address:
  • Phone: 240-535-8013
  • Fax: 240-437-4117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12462
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: