Provider Demographics
NPI:1750872693
Name:WILLIAMS, RYAN (LCPC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E JOPPA RD STE 400
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3109
Mailing Address - Country:US
Mailing Address - Phone:410-828-0101
Mailing Address - Fax:410-828-6262
Practice Address - Street 1:200 E JOPPA RD STE 400
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3109
Practice Address - Country:US
Practice Address - Phone:410-828-0101
Practice Address - Fax:410-828-6262
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-26
Last Update Date:2018-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional