Provider Demographics
NPI:1356090179
Name:WILLIAMS, ANGEL LYNN (B-CAT)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:B-CAT
Other - Prefix:MRS
Other - First Name:ANGEL
Other - Middle Name:LYNN
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 VILLAGE SQ STE 210
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1624
Mailing Address - Country:US
Mailing Address - Phone:866-565-7222
Mailing Address - Fax:877-734-1914
Practice Address - Street 1:6325 N CENTER DR STE 121
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-0012
Practice Address - Country:US
Practice Address - Phone:757-901-0646
Practice Address - Fax:877-734-1914
Is Sole Proprietor?:No
Enumeration Date:2022-03-20
Last Update Date:2024-03-15
Deactivation Date:2022-03-29
Deactivation Code:
Reactivation Date:2022-09-30
Provider Licenses
StateLicense IDTaxonomies
VA0017350106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician