Provider Demographics
NPI:1013030832
Name:DK. ELAINE WILLIAMS, P.C.
Entity Type:Organization
Organization Name:DK. ELAINE WILLIAMS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-383-1386
Mailing Address - Street 1:3615 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3237
Mailing Address - Country:US
Mailing Address - Phone:703-383-1386
Mailing Address - Fax:
Practice Address - Street 1:3615 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE F
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3237
Practice Address - Country:US
Practice Address - Phone:703-383-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-08
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002034103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA618220Medicare ID - Type UnspecifiedOWNER'S PROVIDER ID