Provider Demographics
NPI:1245567718
Name:WILLIAMS, DALE R (LCPC)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:301-627-0399
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:301-627-0399
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCO307101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD286400200Medicaid