Provider Demographics
NPI:1003956897
Name:WILLIAMS, JODI ANN (LPC MH)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 S PATRICIAN CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-1735
Mailing Address - Country:US
Mailing Address - Phone:605-201-3838
Mailing Address - Fax:
Practice Address - Street 1:208 E HOLLY BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-1171
Practice Address - Country:US
Practice Address - Phone:605-201-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD1003101Y00000X
SD2129101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor