Basic Information
| Provider Information | |||||||||
| NPI: | 1619952090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 GIBNER RD | ||||||||
| Address2: | DUNHAM U.S. ARMY HEALTH CLINIC | ||||||||
| City: | CARLISLE BARRACKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170135003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172453041 | ||||||||
| FaxNumber: | 7172453815 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 GIBNER RD | ||||||||
| Address2: | DUNHAM U.S. ARMY HEALTH CLINIC | ||||||||
| City: | CARLISLE BARRACKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170135003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172453041 | ||||||||
| FaxNumber: | 7172453815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CW006868L | PA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.