=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700779287
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FALLON MARIE BRICE-WILLIAMS LMSW 33161- MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2025
-----------------------------------------------------
Last Update Date | 06/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5217 WHITE ROSE DR
-----------------------------------------------------
City | KILLEEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76542-7053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-889-7530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 AMERICAN WAY
-----------------------------------------------------
City | OXON HILL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20745-4500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-889-7530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 33161
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------