Provider Demographics
NPI:1457004707
Name:WILLIAMS, JESSICA K (LPCC, LCADC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPCC, LCADC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:K
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0280
Mailing Address - Country:US
Mailing Address - Phone:606-626-7727
Mailing Address - Fax:606-886-2193
Practice Address - Street 1:838 E MOUNTAIN PKWY
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-8378
Practice Address - Country:US
Practice Address - Phone:606-349-7475
Practice Address - Fax:606-349-7476
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY271723101YA0400X
KY287767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100932580Medicaid
KY7100798210Medicaid