Provider Demographics
NPI:1427067552
Name:WILLIAMS, TERRYLE L (LCSW-C)
Entity type:Individual
Prefix:
First Name:TERRYLE
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:22 BIRCH BARK CT.
Mailing Address - Street 2:
Mailing Address - City:OWING MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1319
Mailing Address - Country:US
Mailing Address - Phone:410-581-0895
Mailing Address - Fax:410-581-0895
Practice Address - Street 1:22 BIRCH BARK CT.
Practice Address - Street 2:
Practice Address - City:OWING MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1319
Practice Address - Country:US
Practice Address - Phone:410-581-0895
Practice Address - Fax:410-581-0895
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD008471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
6231194OtherVALUE OPTIONS
217775OtherKAISER PERMANENTE
223466OtherMAMSI
224979OtherCOM PSYCHE
QX93TLOtherCAREFIRST BC/BS
54955OtherCIGNA
R4550001OtherCAREFIRST BLUE CHOICE
MDPVPB2089OtherAMERICAN PSYCH SYSTEM
MD5383476OtherAETNA
74032OtherUNITED HEALTHCARE
MDPVPB2089OtherAMERICAN PSYCH SYSTEM
R10918Medicare UPIN