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General NPI Number Information
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NPI Number | 1437934916
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Entity Type | Individual
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Provider Name | EBONE- TIYASIA MARIA WILLIAMS MSW, LMHP-S
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Gender | Female
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Dates
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Enumeration Date | 08/31/2023
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 13508 E BOUNDARY RD STE E
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-3989
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Country | US
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Telephone | 804-801-7113
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Fax |
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Provider Business Mailing Address
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Address Line | 5913 BELSTON CT
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23234-3214
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Country | US
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Telephone | 804-252-6144
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0906012374
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License Number State | VA
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