Provider Demographics
NPI:1801195581
Name:WILLIAMS, JACQUELINE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14313 LUSBY RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607
Mailing Address - Country:US
Mailing Address - Phone:240-535-8013
Mailing Address - Fax:240-437-4117
Practice Address - Street 1:9500 MEDICAL CENTER DR STE 230B
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-3707
Practice Address - Country:US
Practice Address - Phone:240-535-8013
Practice Address - Fax:240-437-4117
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD124621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical