Provider Demographics
NPI:1467787093
Name:WILLIAMS, JOHN DONALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DONALD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:D
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1315 W COLLEGE AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2776
Mailing Address - Country:US
Mailing Address - Phone:814-441-5738
Mailing Address - Fax:814-861-5163
Practice Address - Street 1:1315 W COLLEGE AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2776
Practice Address - Country:US
Practice Address - Phone:814-441-5738
Practice Address - Fax:814-861-5163
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004377L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical