Provider Demographics
NPI:1699496794
Name:WILLIAMS, GABRIELLE R (CLC)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 GLEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8911
Mailing Address - Country:US
Mailing Address - Phone:302-236-2323
Mailing Address - Fax:
Practice Address - Street 1:1731 GLEN RIDGE RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-8911
Practice Address - Country:US
Practice Address - Phone:302-236-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD338524174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN