Provider Demographics
NPI:1619952090
Name:WILLIAMS, MARTHA LEE
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LEE
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 1:450 GIBNER RD
Mailing Address - Street 2:DUNHAM U.S. ARMY HEALTH CLINIC
Mailing Address - City:CARLISLE BARRACKS
Mailing Address - State:PA
Mailing Address - Zip Code:17013-5003
Mailing Address - Country:US
Mailing Address - Phone:717-245-3041
Mailing Address - Fax:717-245-3815
Practice Address - Street 1:450 GIBNER RD
Practice Address - Street 2:DUNHAM U.S. ARMY HEALTH CLINIC
Practice Address - City:CARLISLE BARRACKS
Practice Address - State:PA
Practice Address - Zip Code:17013-5003
Practice Address - Country:US
Practice Address - Phone:717-245-3041
Practice Address - Fax:717-245-3815
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW006868L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health