Provider Demographics
NPI:1578631412
Name:WILLIAMS, GWYNETH S
Entity Type:Individual
Prefix:
First Name:GWYNETH
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 14TH ST. NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1207
Mailing Address - Country:US
Mailing Address - Phone:202-531-9617
Mailing Address - Fax:
Practice Address - Street 1:8001 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1207
Practice Address - Country:US
Practice Address - Phone:202-531-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127721041C0700X
DCLC500779141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12772OtherCLINICAL SOCIAL WORKER
DCLC50077914Medicaid