Provider Demographics
NPI:1093967135
Name:WILLIAMS, CHANITA N (LGSW)
Entity Type:Individual
Prefix:MRS
First Name:CHANITA
Middle Name:N
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13403 BADEN WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-8418
Mailing Address - Country:US
Mailing Address - Phone:240-472-8871
Mailing Address - Fax:
Practice Address - Street 1:13403 BADEN WESTWOOD RD
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-8418
Practice Address - Country:US
Practice Address - Phone:240-472-8871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG11027104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker