Provider Demographics
NPI:1356324073
Name:WILLIAMS, KATHLEEN S (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:STACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:8316 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5207
Mailing Address - Country:US
Mailing Address - Phone:703-698-5220
Mailing Address - Fax:703-573-2351
Practice Address - Street 1:14901 BROSCHART RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3318
Practice Address - Country:US
Practice Address - Phone:703-698-5220
Practice Address - Fax:703-573-2351
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD114751041C0700X
VA09040066451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2161608OtherMAMSI
177754OtherVALUEOPTIONS
DC0083OtherCAREFIRST
80861-000OtherMAGELLAN
VA305812OtherANTHEM - VA OFFICE LOCATI
364208OtherMHN
MD180726OtherANTHEM
718320OtherNCPPO
VA305812OtherANTHEM - VA OFFICE LOCATI