Provider Demographics
NPI:1205044856
Name:WILLIAMSON COUNSELING, PLLC
Entity Type:Organization
Organization Name:WILLIAMSON COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, PHD, LCSW
Authorized Official - Phone:253-232-9905
Mailing Address - Street 1:5126 80TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4049
Mailing Address - Country:US
Mailing Address - Phone:253-232-9905
Mailing Address - Fax:253-474-0189
Practice Address - Street 1:4020 S 56TH ST STE 210
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2619
Practice Address - Country:US
Practice Address - Phone:253-232-9905
Practice Address - Fax:253-474-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000036581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0102175Medicare ID - Type Unspecified