MEDICARE: DR. SHANNON RENEE WILLIAMS PH.D., LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LC1245	MD
2	101YP2500X	Professional Counselor	LC1245	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720130297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON RENEE WILLIAMS PH.D., LCPC

Provider Business Mailing Address
First Line	:	17203 CLAIRFIELD LN
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3335
Country	:	US
Telephone Number	:	301-627-0568
Fax Number	:	301-780-5332

Provider Business Practice Location Address
First Line	:	9500 ARENA DR STE 460B
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-3755
Country	:	US
Telephone Number	:	301-627-0568
Fax Number	:	301-841-8011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	03/17/2018

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