Provider Demographics
NPI:1174514392
Name:BRIM, WILLIAM LOUIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LOUIS
Last Name:BRIM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1295
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-1295
Mailing Address - Country:US
Mailing Address - Phone:410-570-1163
Mailing Address - Fax:
Practice Address - Street 1:301 STEEPLE CHASE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4049
Practice Address - Country:US
Practice Address - Phone:410-570-1163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2608103TC0700X
MD04405103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service