Provider Demographics
NPI:1194539650
Name:WILLIAMS, EMMALEE PEYTON (EDS, NCSP)
Entity type:Individual
Prefix:
First Name:EMMALEE
Middle Name:PEYTON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9075 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4317
Mailing Address - Country:US
Mailing Address - Phone:571-377-6216
Mailing Address - Fax:
Practice Address - Street 1:9075 PARK AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4317
Practice Address - Country:US
Practice Address - Phone:571-377-6216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-0608885103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool