Provider Demographics
NPI:1801952759
Name:WILLIAMS, SHIRLEY MINERVA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:MINERVA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9405 LARKDALE TER
Mailing Address - Street 2:FAIRFAX STATION
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3136
Mailing Address - Country:US
Mailing Address - Phone:703-690-6320
Mailing Address - Fax:703-690-6320
Practice Address - Street 1:9405 LARKDALE TERRACE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22039-3136
Practice Address - Country:US
Practice Address - Phone:703-690-6320
Practice Address - Fax:703-690-6320
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040037991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical