Provider Demographics
NPI:1710432760
Name:WILLIAMS, SHATINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHATINA
Middle Name:
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 1:3410 HEWITT AVE
Mailing Address - Street 2:APT 103
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5407
Mailing Address - Country:US
Mailing Address - Phone:310-940-5172
Mailing Address - Fax:
Practice Address - Street 1:8120 WOODMONT AVE
Practice Address - Street 2:205
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2743
Practice Address - Country:US
Practice Address - Phone:301-547-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05788103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling