Provider Demographics
NPI:1528256559
Name:WILLIAMS, WANDA III (LCSW)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:
Last Name:WILLIAMS
Suffix:III
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5710
Mailing Address - Country:US
Mailing Address - Phone:410-727-0674
Mailing Address - Fax:
Practice Address - Street 1:2113 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5710
Practice Address - Country:US
Practice Address - Phone:410-727-0674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04501171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator