Provider Demographics
NPI:1861759359
Name:WILLIAMS, COLLEEN MARY (BCBA)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:MARY
Other - Last Name:PRYOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21913 FOXLAIR RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20882-1306
Mailing Address - Country:US
Mailing Address - Phone:240-361-7178
Mailing Address - Fax:
Practice Address - Street 1:21913 FOXLAIR RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20882-1306
Practice Address - Country:US
Practice Address - Phone:240-361-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-11-8537103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst