Basic Information
| Provider Information | |||||||||
| NPI: | 1366857237 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | BASHEA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20121 ROTHBURY LN | ||||||||
| Address2: | UNIT 105 | ||||||||
| City: | MONTGOMERY VILLAGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208861448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014425653 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16620 FREDERICK ROAD | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013451022 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2014 | ||||||||
| LastUpdateDate: | 05/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 15823 | MD | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.