Provider Demographics
NPI:1366857237
Name:WILLIAMS, PAUL BASHEA
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:BASHEA
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20121 ROTHBURY LN
Mailing Address - Street 2:UNIT 105
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-1448
Mailing Address - Country:US
Mailing Address - Phone:301-442-5653
Mailing Address - Fax:
Practice Address - Street 1:16620 FREDERICK ROAD
Practice Address - Street 2:SUITE 310
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877
Practice Address - Country:US
Practice Address - Phone:301-345-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15823104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker