Provider Demographics
NPI:1033156971
Name:WILLIAMS-MADRAY COUNSELING SERVICE
Entity Type:Organization
Organization Name:WILLIAMS-MADRAY COUNSELING SERVICE
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL PROFESSIONAL COUN
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:301-627-0399
Mailing Address - Street 1:14007 BUCK CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6821
Mailing Address - Country:US
Mailing Address - Phone:301-922-1334
Mailing Address - Fax:301-627-7421
Practice Address - Street 1:14007 BUCK CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-6821
Practice Address - Country:US
Practice Address - Phone:301-922-1334
Practice Address - Fax:301-627-7421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCO307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty