Provider Demographics
NPI:1164736062
Name:WILLIAMSON, JAMIE ANN
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ANN
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:EMINENCE
Mailing Address - State:KY
Mailing Address - Zip Code:40019-1328
Mailing Address - Country:US
Mailing Address - Phone:502-835-2289
Mailing Address - Fax:502-287-6197
Practice Address - Street 1:800 ZORN AVE
Practice Address - Street 2:7TH FLOOR, RM B-728
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1433
Practice Address - Country:US
Practice Address - Phone:502-287-4639
Practice Address - Fax:502-287-6197
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor