Provider Demographics
NPI:1437934916
Name:WILLIAMS, EBONE- TIYASIA MARIA (MSW, LMHP-S)
Entity Type:Individual
Prefix:
First Name:EBONE- TIYASIA
Middle Name:MARIA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW, LMHP-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5913 BELSTON CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-3214
Mailing Address - Country:US
Mailing Address - Phone:804-252-6144
Mailing Address - Fax:
Practice Address - Street 1:13508 E BOUNDARY RD STE E
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3989
Practice Address - Country:US
Practice Address - Phone:804-801-7113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060123741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical