Healthcare Provider Details

I. General information

NPI: 1427067552
Provider Name (Legal Business Name): TERRYLE L WILLIAMS LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TERRY WILLIAMS LCSW-C

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BIRCH BARK CT.
OWING MILLS MD
21117-1319
US

IV. Provider business mailing address

22 BIRCH BARK CT.
OWING MILLS MD
21117-1319
US

V. Phone/Fax

Practice location:
  • Phone: 410-581-0895
  • Fax: 410-581-0895
Mailing address:
  • Phone: 410-581-0895
  • Fax: 410-581-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00847
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: