Provider Demographics
NPI:1629015896
Name:WILLIAMS, JAMIE (PSYD LMHC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PSYD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CLUB DRIVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864
Mailing Address - Country:US
Mailing Address - Phone:401-273-2381
Mailing Address - Fax:
Practice Address - Street 1:260 W EXCHANGE ST
Practice Address - Street 2:STE 307
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-273-2386
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00192101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJW51424Medicaid