Provider Demographics
NPI:1215459912
Name:WILLIAMS, GRETCHEN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13016 MARTHAS CHOICE CIR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4700
Mailing Address - Country:US
Mailing Address - Phone:301-512-9473
Mailing Address - Fax:
Practice Address - Street 1:14300 GALLANT FOX LN STE 115
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4031
Practice Address - Country:US
Practice Address - Phone:571-236-7012
Practice Address - Fax:571-236-7012
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5517101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional