Provider Demographics
NPI:1245242049
Name:WILLIAMS, ELLEN (PHD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4317
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-396-8966
Practice Address - Street 1:4160 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4317
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-396-8966
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7038103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral