Provider Demographics
NPI:1881867133
Name:WILLIAMSON, JONI LACHELLE (PSYD)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:LACHELLE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GREENWAY ST NW STE 5
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3557
Mailing Address - Country:US
Mailing Address - Phone:410-760-9079
Mailing Address - Fax:410-760-1121
Practice Address - Street 1:30 GREENWAY ST NW STE 5
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3557
Practice Address - Country:US
Practice Address - Phone:410-760-9079
Practice Address - Fax:410-760-1121
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04225103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist