Provider Demographics
NPI:1174863682
Name:WILLIAMS, STANLEY ALLEN (LMFT)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:ALLEN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 BRENTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3241
Mailing Address - Country:US
Mailing Address - Phone:904-315-1586
Mailing Address - Fax:
Practice Address - Street 1:17 PACIFIC ST STE B
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2784
Practice Address - Country:US
Practice Address - Phone:904-315-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2667106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist