Provider Demographics
NPI:1447976410
Name:WILLIAMS, RENARDIS E (LICSW)
Entity type:Individual
Prefix:
First Name:RENARDIS
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 SIERRA NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2687
Mailing Address - Country:US
Mailing Address - Phone:704-968-1186
Mailing Address - Fax:
Practice Address - Street 1:2611 SIERRA NEVADA AVE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-2687
Practice Address - Country:US
Practice Address - Phone:704-968-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000013831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1720229958Medicaid