Provider Demographics
NPI:1023207966
Name:WILLIAMS, LEVERN CLAY JR (LCPC)
Entity Type:Individual
Prefix:MR
First Name:LEVERN
Middle Name:CLAY
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 WEDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-1225
Mailing Address - Country:US
Mailing Address - Phone:443-540-0753
Mailing Address - Fax:
Practice Address - Street 1:27 MELLOR AVE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5106
Practice Address - Country:US
Practice Address - Phone:410-453-9553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413756600Medicaid