Provider Demographics
NPI:1184941114
Name:WILLIAMS, MARY WRIGHT (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:WRIGHT
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:WILLIAMS
Other - Last Name:MONTAGUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-0695
Mailing Address - Country:US
Mailing Address - Phone:804-832-1953
Mailing Address - Fax:
Practice Address - Street 1:444 WATER LN
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-5090
Practice Address - Country:US
Practice Address - Phone:804-832-1953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002720101YP2500X
VA0717000645106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional