Provider Demographics
NPI:1073200465
Name:WILLIAMS, LAURIE JEAN
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:JEAN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, MACI, CACI
Mailing Address - Street 1:508 KENNEDY ST NW UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3137
Mailing Address - Country:US
Mailing Address - Phone:202-223-9630
Mailing Address - Fax:202-223-9632
Practice Address - Street 1:508 KENNEDY ST NW UNIT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3137
Practice Address - Country:US
Practice Address - Phone:202-948-6707
Practice Address - Fax:202-223-9632
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACI1074101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)