Provider Demographics
NPI:1750908356
Name:WILLIAMS, TRACEY LYNNE (LCSW,C)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LYNNE
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 1:8312 GOVERNOR GRAYSON WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3450
Mailing Address - Country:US
Mailing Address - Phone:443-253-4398
Mailing Address - Fax:
Practice Address - Street 1:8312 GOVERNOR GRAYSON WAY
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3450
Practice Address - Country:US
Practice Address - Phone:443-253-4398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD139991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical