Provider Demographics
NPI:1598224651
Name:WILLIAMS, RONALD (LCADC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12341 QUARTERBACK CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4398
Mailing Address - Country:US
Mailing Address - Phone:102-028-4870
Mailing Address - Fax:
Practice Address - Street 1:12341 QUARTERBACK CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4398
Practice Address - Country:US
Practice Address - Phone:202-848-7043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCADC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty