Provider Demographics
NPI:1346089836
Name:WILLIAMS, EVELYN MARIE
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 WALLACE AVE APT 6J
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-1849
Mailing Address - Country:US
Mailing Address - Phone:917-683-7838
Mailing Address - Fax:
Practice Address - Street 1:2157 WALLACE AVE APT 6J
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-1849
Practice Address - Country:US
Practice Address - Phone:917-683-7838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor