Provider Demographics
NPI:1760976773
Name:WILLIAMS, JORDACHE (LPC)
Entity Type:Individual
Prefix:
First Name:JORDACHE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36652
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-0510
Mailing Address - Country:US
Mailing Address - Phone:803-681-0778
Mailing Address - Fax:803-909-9064
Practice Address - Street 1:1030 RIVERWALK PKWY STE 204
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4265
Practice Address - Country:US
Practice Address - Phone:803-681-0778
Practice Address - Fax:803-909-9064
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional