1356324073 NPI number — KATHLEEN S WILLIAMS LCSW-C

Table of content: KATHLEEN S WILLIAMS LCSW-C (NPI 1356324073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356324073 NPI number — KATHLEEN S WILLIAMS LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
KATHLEEN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STACK
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356324073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8316 ARLINGTON BLVD
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-5207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-698-5220
Provider Business Mailing Address Fax Number:
703-573-2351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14901 BROSCHART RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-3318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-698-5220
Provider Business Practice Location Address Fax Number:
703-573-2351
Provider Enumeration Date:
11/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  11475 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 0904006645 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2161608 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 177754 . This is a "VALUEOPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0083 . This is a "CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 80861-000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 305812 . This is a "ANTHEM - VA OFFICE LOCATI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 364208 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180726 . This is a "ANTHEM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 718320 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".




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