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General NPI Number Information
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NPI Number | 1457038382
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Entity Type | Individual
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Provider Name | KEYANNA D WILLIAMS
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Gender | Female
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 3605 COURTLEIGH DR
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-4806
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Country | US
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Telephone | 443-392-6934
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Fax |
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Provider Business Mailing Address
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Address Line | 3640 CONCORD PIKE
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City | WILMINGTON
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State | DE
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Zip | 19803-5022
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Country | US
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Telephone |
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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