Provider Demographics
NPI:1902531726
Name:WILLIAMS, ANTONIO TWANE (MS)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:TWANE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 GEORGIA AVE APT 1713
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-7672
Mailing Address - Country:US
Mailing Address - Phone:301-310-8689
Mailing Address - Fax:
Practice Address - Street 1:11215 GEORGIA AVE APT 1713
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-7672
Practice Address - Country:US
Practice Address - Phone:301-310-8689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health