Provider Demographics
NPI:1235845702
Name:WILLIAMS, JENNIFER D (LPC)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 RIDGEBEND DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31028-1604
Mailing Address - Country:US
Mailing Address - Phone:478-225-7051
Mailing Address - Fax:
Practice Address - Street 1:226 RIDGEBEND DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31028-1604
Practice Address - Country:US
Practice Address - Phone:478-225-7051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC003839OtherLICENSED PROFESSIONAL COUNSELOR