Provider Demographics
NPI:1497192520
Name:WILLIAMS, JASON (CADC-I)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 LAMOILLE HWY STE 208
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-4397
Mailing Address - Country:US
Mailing Address - Phone:775-738-4158
Mailing Address - Fax:775-753-6487
Practice Address - Street 1:1250 LAMOILLE HWY STE 208
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4397
Practice Address - Country:US
Practice Address - Phone:775-738-4158
Practice Address - Fax:775-753-6487
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01062-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)