=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043751217
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELINDA E WILLIAMS-GRAY PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2017
-----------------------------------------------------
Last Update Date | 08/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2139 ESPEY COURT SUITE 2
-----------------------------------------------------
City | CROFTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-810-4148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12138 CENTRAL AVE STE 176
-----------------------------------------------------
City | MITCHELLVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20721-1910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-810-4148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | PSY1001152
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------