Healthcare Provider Details

I. General information

NPI: 1912700972
Provider Name (Legal Business Name): KHADIJAH WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 WINDRIM AVE
PHILADELPHIA PA
19141-2710
US

IV. Provider business mailing address

3708 MANTUA AVE
PHILADELPHIA PA
19104-1630
US

V. Phone/Fax

Practice location:
  • Phone: 215-455-3900
  • Fax:
Mailing address:
  • Phone: 267-271-7737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: