Provider Demographics
NPI:1669646188
Name:WILLIAMS, KATHRYN ELAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ELAINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3237
Mailing Address - Country:US
Mailing Address - Phone:703-383-1386
Mailing Address - Fax:
Practice Address - Street 1:3615 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE F
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3237
Practice Address - Country:US
Practice Address - Phone:703-383-1386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2034103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
618220Medicare PIN