Provider Demographics
NPI:1093563041
Name:WILLIAMS, JUSTINE R (CSAC)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5709 GUY PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-2807
Mailing Address - Country:US
Mailing Address - Phone:703-994-8211
Mailing Address - Fax:
Practice Address - Street 1:10513 JUDICIAL DR STE 101
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7528
Practice Address - Country:US
Practice Address - Phone:703-828-7274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103316101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)