Provider Demographics
NPI:1700410024
Name:WILLIAMS, JONATHAN P (LCMHC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 HOUNDSCROFT RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-8814
Mailing Address - Country:US
Mailing Address - Phone:704-231-5597
Mailing Address - Fax:
Practice Address - Street 1:1006 HOUNDSCROFT RD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-8814
Practice Address - Country:US
Practice Address - Phone:980-263-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15598101YM0800X
NC15598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health