Healthcare Provider Details

I. General information

NPI: 1174120935
Provider Name (Legal Business Name): LAKISHA M WILLIAMS DHA, CRNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 EDGEMEADE RD
UPPER MARLBORO MD
20772-8088
US

IV. Provider business mailing address

14605 ELM ST UNIT 1153
UPPER MARLBORO MD
20773-7541
US

V. Phone/Fax

Practice location:
  • Phone: 301-358-0192
  • Fax:
Mailing address:
  • Phone: 202-681-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR159166
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: