SR 201 begins at an intersection with SR 354 (River Road) near the hamlet of Mollusk. The state highway heads northeast as White Chapel Road and crosses Little Branch, a tributary of the Western Branch of the Corrotoman River. SR 201 intersects SR 3 (Historyland Highway) in the hamlet of Lively and crosses the Belwood Swamp on its way to McNeals Corner. There, the state highway turns north onto Court House Road. Courthouse Road heads south as SR 600 toward the Lancaster County seat of Lancaster; the 0.11-mile (0.18 km) long curved spur between SR 201 and SR 600 is SR 201Y. SR 201 has a right-angle turn south of Miskimon; from there to Miskimon, the state highway runs on top of the Lancaster–Northumberland county line. The county line is also the height of land between the Corrotoman River drainage, which empties into the Rappahannock River, and the watershed of the Great Wicomico River, which flows directly into the Chesapeake Bay. SR 201 fully enters Northumberland County at Miskimon and has another sharp turn at Howland. The state highway crosses the two streams that form the Great Wicomico River—Bush Mill Stream and Crabbs Mill Stream—before reaching its northern terminus at US 360 (Northumberland Highway) in Heathsville.[1][2]