Provider Demographics
NPI:1619694940
Name:WILLIAMS, ZACKERY LWW
Entity Type:Individual
Prefix:MR
First Name:ZACKERY
Middle Name:LWW
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 BOSTON WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-5909
Mailing Address - Country:US
Mailing Address - Phone:573-528-9445
Mailing Address - Fax:
Practice Address - Street 1:246 BOSTON WAY
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-5909
Practice Address - Country:US
Practice Address - Phone:573-528-9445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22371101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health