Provider Demographics
NPI:1922525617
Name:WILLIAMS, SAMARIA (LSW)
Entity Type:Individual
Prefix:
First Name:SAMARIA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2716
Mailing Address - Country:US
Mailing Address - Phone:267-625-4918
Mailing Address - Fax:
Practice Address - Street 1:18 ROSE LN
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2716
Practice Address - Country:US
Practice Address - Phone:267-625-4918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9707101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)