Healthcare Provider Details

I. General information

NPI: 1609316843
Provider Name (Legal Business Name): KYLYNN BRIANA WILLIAMS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 COOMBS FARM RD
MORGANTOWN WV
26508-0053
US

IV. Provider business mailing address

116 KLOTZ FARM DR
MC HENRY MD
21541-1155
US

V. Phone/Fax

Practice location:
  • Phone: 304-381-2211
  • Fax:
Mailing address:
  • Phone: 814-229-9864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC9882
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC009489
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2475
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: