Provider Demographics
NPI:1194381517
Name:WILLIAMS, KEYAIRA (MS)
Entity Type:Individual
Prefix:
First Name:KEYAIRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 KESWICK RD APT 3
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2575
Mailing Address - Country:US
Mailing Address - Phone:301-875-6630
Mailing Address - Fax:
Practice Address - Street 1:920 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2975
Practice Address - Country:US
Practice Address - Phone:877-893-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health