Provider Demographics
NPI:1780114405
Name:WILLIAMS, MONIQUE LA SHON (RPSGT)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:LA SHON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 MAIN LINE BLVD APT 650
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-2930
Mailing Address - Country:US
Mailing Address - Phone:571-263-1484
Mailing Address - Fax:
Practice Address - Street 1:1221 MERCANTILE LN STE 203
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5374
Practice Address - Country:US
Practice Address - Phone:301-618-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDZ00016246Z00000X
VA0135000097246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other