Provider Demographics
NPI:1649756693
Name:WILLIAMS, MARVA C (MDIV, MACMHC)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MDIV, MACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 SAVANNAH CT
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-6341
Mailing Address - Country:US
Mailing Address - Phone:919-302-7522
Mailing Address - Fax:
Practice Address - Street 1:2680 OPITZ BLVD STE 220
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6821
Practice Address - Country:US
Practice Address - Phone:703-828-8053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704011406101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor