Provider Demographics
NPI:1790986693
Name:WILLIAMS, JACQUELINE GAMBLE (ASSESSMENT SPECIALIS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:GAMBLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ASSESSMENT SPECIALIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 NETTLEBROOK ST S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-1007
Mailing Address - Country:US
Mailing Address - Phone:904-714-6462
Mailing Address - Fax:
Practice Address - Street 1:390 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-2342
Practice Address - Country:US
Practice Address - Phone:904-899-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)