Provider Demographics
NPI:1730671132
Name:WILLIAMS, JACOBIA JOI (LCSW)
Entity Type:Individual
Prefix:
First Name:JACOBIA
Middle Name:JOI
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0526
Mailing Address - Country:US
Mailing Address - Phone:704-780-5997
Mailing Address - Fax:
Practice Address - Street 1:2716 HIGHLAND PARK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0526
Practice Address - Country:US
Practice Address - Phone:704-780-5997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0095351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical