Provider Demographics
NPI:1184981243
Name:WILLIAMS, TINESHA C (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TINESHA
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 GREENMEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:301-806-3760
Mailing Address - Fax:
Practice Address - Street 1:6915 LAUREL-BOWIE ROAD
Practice Address - Street 2:SUITE 205-B
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20774
Practice Address - Country:US
Practice Address - Phone:240-245-4370
Practice Address - Fax:240-245-4472
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist