Provider Demographics
NPI:1003993619
Name:WILLIAMS, JACKIE ALLEN (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:ALLEN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 NALE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8770
Mailing Address - Country:US
Mailing Address - Phone:256-430-4797
Mailing Address - Fax:
Practice Address - Street 1:4800 WHITESPORT CIR SW
Practice Address - Street 2:#2
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6444
Practice Address - Country:US
Practice Address - Phone:256-533-9393
Practice Address - Fax:256-533-9690
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0583-1498C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker