Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 0904004522 | VA |
N | 1041C0700X | Clinical Social Worker | 10541 | MD |
NPI | 1003223991 |
---|---|
Provider Name | Jennie Linn Williams |
First Address | Glen Burnie, MD 21061-3398 |
Second Address | Glen Burnie, MD 21061-3398 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2014 |
Last Update Date | 02/11/2017 |