Provider Demographics
NPI:1285479097
Name:WILLIAMS, OTIS III (LGPC)
Entity type:Individual
Prefix:
First Name:OTIS
Middle Name:
Last Name:WILLIAMS
Suffix:III
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 REISTERSTOWN RD # 1354
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3803
Mailing Address - Country:US
Mailing Address - Phone:410-296-2004
Mailing Address - Fax:
Practice Address - Street 1:2076 SAGRAMORE LN
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3798
Practice Address - Country:US
Practice Address - Phone:410-296-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional