Provider Demographics
NPI:1437867215
Name:WILLIAMS, JAZZMINE K (MS, LPC-S, NCC, CMHT)
Entity Type:Individual
Prefix:
First Name:JAZZMINE
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, LPC-S, NCC, CMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 HATHAWAY DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5326
Mailing Address - Country:US
Mailing Address - Phone:601-460-1747
Mailing Address - Fax:
Practice Address - Street 1:1855 CRANE RIDGE DR STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4944
Practice Address - Country:US
Practice Address - Phone:601-460-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2173101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health