Provider Demographics
NPI:1952414534
Name:WILLIAMS, KENNETH O (MA)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:O
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9650 SANTIAGO RD
Mailing Address - Street 2:SUITE 101-102
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3957
Mailing Address - Country:US
Mailing Address - Phone:410-995-5587
Mailing Address - Fax:410-992-1779
Practice Address - Street 1:9650 SANTIAGO RD
Practice Address - Street 2:SUITE 101-102
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3957
Practice Address - Country:US
Practice Address - Phone:410-995-5587
Practice Address - Fax:410-992-1779
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0119101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional