Provider Demographics
NPI:1215411087
Name:WILLIAMS, ANNETTE IVINA (LMSW)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:IVINA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E NORTHERN PKWY STE T5
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2120
Mailing Address - Country:US
Mailing Address - Phone:410-645-1000
Mailing Address - Fax:
Practice Address - Street 1:1900 E NORTHERN PKWY STE T5
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2120
Practice Address - Country:US
Practice Address - Phone:410-645-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17884101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health